TEST BANK for Clayton’s Basic Pharmacology for Nurses 19th Edition by Willihnganz, Gurevitz

Chapter 01: Drug Definitions, Standards, and Information Sources Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which name identifies a drug listed by the US Food and Drug Administration (FDA)? a. Brand b. Nonproprietary c. Official d. Trademark ANS: C

The official name is the name under which a drug is listed by the FDA. The brand name, or trademark, is the name given to a drug by its manufacturer. The nonproprietary, or generic, name is provided by the United States Adopted Names Council.

DIF: Cognitive Level: Knowledge REF: p. 9 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Patient Education 2. Which source contains information specific to nutritional supplements? a. USP Dictionary of USAN & International Drug Names b. Natural Medicines Comprehensive Database c. United States Pharmacopoeia/National Formulary (USP NF) d. Drug Interaction Facts ANS: C

United States Pharmacopoeia/National Formulary contains information specific to nutritional supplements. USP Dictionary of USAN & International Drug Names is a compilation of drug names, pronunciation guide, and possible future FDA approved drugs; it does not include nutritional supplements. Natural Medicines Comprehensive Database contains evidence-based information on herbal medicines and herbal combination products; it does not include information specific to nutritional supplements. Drug Interaction Facts contains comprehensive information on drug interaction facts; it does not include nutritional supplements.

DIF: Cognitive Level: Knowledge REF: p. 4 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Nutrition | Patient Education 3. Which drug reference contains drug monographs that describe all drugs in a therapeutic class? a. Drug Facts and Comparisons b. Drug Interaction Facts c. Handbook on Injectable Drugs d. Martindale—The Complete Drug Reference ANS: A

Drug Facts and Comparisons contains drug monographs that describe all drugs in a therapeutic class. Monographs are formatted as tables to allow comparison of similar products, brand names, manufacturers, cost indices, and available dosage forms

Online version is available.

DIF: Cognitive Level: Knowledge REF: p. 4 Table 1.2 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Safety | Patient Education | Clinical Judgment 4. Which drug reference contains monographs about virtually every single-entity drug available

in the United States and describes therapeutic uses of drugs, including approved and unapproved uses? a. Martindale: The Complete Drug Reference b. AHFS Drug Information c. Drug Reference d. Drug Facts and Comparisons ANS: B

AHFS Drug Information contains monographs about virtually every single-entity drug available in the United States and describes therapeutic uses of drugs, including approved and unapproved uses.

DIF: Cognitive Level: Knowledge REF: p. 4 Table 1.2 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Safety | Patient Education | Clinical Judgment 5. Which online drug reference makes available to healthcare providers and the public a

standard, comprehensive, up-to-date look up and downloadable resource about medicines? a. American Drug Index b. American Hospital Formulary c. DailyMed d. Drug Reference ANS: C

DailyMed makes available to healthcare providers and the public a standard, comprehensive, up-to-date look up and downloadable resource about medicines. The American Drug Index is not appropriate for patient use. The American Hospital Formulary is not appropriate for patient use. The drug reference is not appropriate for patient use.

DIF: Cognitive Level: Knowledge REF: p. 3 | p. 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Safety | Patient Education | Clinical Judgment

OBJ: 3

6. Which legislation authorizes the FDA to determine the safety of a drug before its marketing? a. Federal Food, Drug, and Cosmetic Act (1938) b. Durham Humphrey Amendment (1952) c. Controlled Substances Act (1970) d. Kefauver Harris Drug Amendment (1962) ANS: A

The Federal Food, Drug, and Cosmetic Act of 1938 authorized the FDA to determine the safety of all drugs before marketing. Later amendments and acts helped tighten FDA control and ensure drug safety. The Durham Humphrey Amendment defines the kinds of drugs that cannot be used safely without medical supervision and restricts their sale to prescription by a licensed practitioner. The Controlled Substances Act addresses only controlled substances and their categorization. The Kefauver Harris Drug Amendment ensures drug efficacy and greater drug safety. Drug manufacturers are required to prove to the FDA the effectiveness of their products before marketing them.

DIF: Cognitive Level: Knowledge REF: p. 5 Table l.3 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Safety | Patient Education | Evidence | Health Care Law 7. Which classification does meperidine (Demerol) fall under? a. I b. II c. III d. IV ANS: B

Meperidine (Demerol) is a Schedule II drug; it has a high potential for abuse and may lead to severe psychological and physical dependence. Schedule I drugs have high potential for abuse and no recognized medical use. Schedule III drugs have some potential for abuse. Use may lead to low to moderate physical dependence or high psychological dependence. Schedule IV drugs have low potential for abuse. Use may lead to limited physical or psychological dependence.

DIF: Cognitive Level: Knowledge REF: p. 10 OBJ: 2 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Patient Education | Addiction | Pain 8. Which action would the FDA take to expedite drug development and approval for an outbreak

of smallpox? a. List smallpox as a health orphan disease. b. Omit the preclinical research phase. c. Extend the clinical research phase. d. Fast track the investigational drug.

ANS: D

Once the Investigational New Drug Application has been approved, the drug can receive highest priority within the agency, which is called fast tracking. A smallpox outbreak would become a priority concern in the world. Orphan diseases are not researched in a priority manner. Preclinical research is not omitted. Extending any phase of the research would mean a longer time to develop a vaccine. The FDA must ensure that all phases of the preclinical and clinical research phase have been completed in a safe manner.

DIF: Cognitive Level: Knowledge REF: p. 7 OBJ: 5 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Health Care Law | Health Care Policy | Infection | Care Coordination

9. Which statement is true about over-the-counter (OTC) drugs? a. They are not listed in the USP NF. b. A prescription from a healthcare provider is needed. c. They are sold without a prescription. d. They are known only by their brand names.

ANS: C

OTC medications do not require a prescription. A variety of names, both generic and trade, can be used for individual drugs sold OTC. OTC drugs are listed in the USP NF. Prescription drugs require an order by a health professional who is licensed to prescribe, such as a physician, nurse practitioner, physician assistant, or dentist.

DIF: Cognitive Level: Comprehension REF: p. 2 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Patient Education 10. Which is the most authoritative reference for medications that are injected? a. Martindale: The Complete b. Handbook on Injectable Drugs c. DailyMed d. Handbook of Nonprescription Drugs ANS: B

The Handbook on Injectable Drugs is the most comprehensive reference available on the topic of compatibility of injectable drugs. It is a collection of monographs for more than 300 injectable drugs that are listed alphabetically by generic name.

DIF: Cognitive Level: Knowledge REF: p. 4 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 11. Which statement is true about Lomotil? a. Abuse potential for this drug is low. b. Psychological dependency is likely. c. There is a high potential for abuse. d. This drug is not a controlled substance.

ANS: A

Lomotil, a Schedule V drug, has an abuse potential of limited physical or psychological dependence liability compared with drugs in Schedule IV. Because abuse potential is low with a Schedule V drug, a prescription may not be required. Psychological dependency is not likely with a Schedule V drug. Schedule V drugs are classified as controlled substances.

DIF: Cognitive Level: Knowledge REF: p. 5 Box 1.1 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Patient Education 12. Which medication ordered for a patient with a substance abuse history has the greatest risk for

abuse? a. Lomotil b. Diazepam

c. Phenobarbital d. Lortab ANS: D

Lortab is a Schedule III drug with a high potential for abuse but less so than drugs in Schedules I and II. Lomotil is a Schedule V drug with a low potential for abuse compared with those in Schedule V. Diazepam is a Schedule IV drug with a low potential for abuse compared with those in schedule III. Phenobarbital is a Schedule IV drug with a low potential for abuse compared with those in Schedule III. DIF: Cognitive Level: Application REF: p. 5 Box 1.1 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Addiction | Patient Education | Safety 13. An older adult experiencing shortness of breath is brought to the hospital by her daughter.

While obtaining the medication history from the patient and her daughter, the nurse discovers that neither has a list of the patient‘s current medications or prescriptions. The patient has is a weekly pill dispenser that contains four different pills. The prescriptions are filled through the local pharmacy. Which resource would be appropriate to use in determining the medication names and doses? a. Martindale—The Complete Drug Reference b. Drugs and Facts Comparisons c. Senior citizens‘ center d. Patient‘s home pharmacy ANS: D

The patient‘s pharmacy would have an accurate account of all the medications the client is currently taking. Martindale—The Complete Drug Reference has written information on medications and would not be an appropriate resource. Drugs and Facts Comparisons contains drug monographs that describe all drugs in a therapeutic class but would not help identify medications by photograph. The senior citizens‘ center is not likely to have specific patient medication information.

DIF: Cognitive Level: Application REF: p. 2 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Care Coordination | Safety | Patient Education | Clinical Judgment MULTIPLE RESPONSE 1. Which statement(s) will be included when planning patient teaching regarding drug names?

(Select all that apply.) a. Most drug companies place their products on the market under generic names. b. The official name is the name under which the drug is listed by the US Food and Drug Administration (FDA). c. Brand names are easier to pronounce, spell, and remember. d. The first letter of the generic name is not capitalized. e. The chemical name is most meaningful to the patient.

ANS: B, C, D

The official name is the name under which the drug is listed by the FDA. Brand names are easier to pronounce, spell, and remember. The first letter of the generic name is not capitalized. Most drug companies place their products on the market under brand names instead of generic names. The chemical name is most meaningful to the chemist.

DIF: Cognitive Level: Comprehension REF: p. 2 | p. 9 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Patient Education | Clinical Judgment | Safety 2. Which drug(s) would be considered to be in the category Schedule II? (Select all that apply.) a. Marijuana b. Percodan c. Amphetamines d. Fiorinal e. Flurazepam ANS: B, C

Schedule II drugs have a high potential for abuse, they are currently accepted in the United States, and use may lead to severe psychological or physical dependence. Percodan and amphetamines are considered Schedule II drugs. Marijuana is a Schedule I drug. Fiorinal is a Schedule III drug. Flurazepam is a Schedule IV drug.

DIF: Cognitive Level: Comprehension REF: p. 5 Box 1.1 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Addiction | Clinical Judgment | Patient Education

Chapter 02: Basic Principles of Drug Action and Drug Interactions Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which priority action should be implemented when hives are assessed on a patient started on a

new medication? a. Notify physician of allergic reaction. b. Notify physician of idiosyncratic reaction. c. Notify physician of potential teratogenicity. d. Notify physician of potential tolerance.

ANS: A

An allergic reaction is indicative of hypersensitivity and manifests with hives and/or urticaria, which are easily identified. An idiosyncratic reaction occurs when something unusual or abnormal happens when a drug is first administered. A teratogenic reaction refers to the occurrence of birth defects related to administration of the drug. Tolerance refers to the body‘s requirement for increasing dosages to achieve the same effects that a lower dose once did.

DIF: Cognitive Level: Application REF: p. 17 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety

2. The nurse administers an initial dose of a steroid to a patient with asthma. Thirty minutes after

administration, the nurse finds the patient agitated and stating that ―everyone is out to get me.‖ Which term is used for this unusual reaction? a. Desired action b. Adverse effect c. Idiosyncratic reaction d. Allergic reaction ANS: C

Idiosyncratic reactions are unusual, abnormal reactions that occur when a drug is first administered. Patients typically exhibit an overresponsiveness to a medication related to diminished metabolism. These reactions are believed to be related to genetic enzyme deficiencies. Desired actions are expected responses to a medication. Adverse effects are reactions that occur in another system of the body; they are usually predictable. Allergic reactions appear after repeated medication dosages.

DIF: Cognitive Level: Knowledge REF: p. 18 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Patient Education | Clinical Judgment | Caregiving | Safety | Sensory Perception 3. Which is the best description of when drug interactions occur? a. On administration of toxic dosages of a drug b. On an increase in the pharmacodynamics of bound drugs c. On the alteration of the effect of one drug by another drug d. On increase of drug excretion ANS: C

Drug interactions may be characterized by an increase or decrease in the effectiveness of one or both of the drugs. Toxicity of one drug may or may not affect the metabolism of another one. Drug interactions may result from either increased or decreased pharmacodynamics.

Drug interactions may result from either increased or decreased excretion.

DIF: Cognitive Level: Comprehension REF: p. 18 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Safety | Patient Education | Clinical Judgment 4. Which term describes when two drugs compete for the same receptor site, resulting in

increased activity of the first drug? a. Desired action b. Synergistic effect c. Carcinogenicity d. Displacement ANS: D

The displacement of the first drug from receptor sites by a second drug increases the amount of the first drug because more unbound drug is available. An expected response of a drug is the desired action. A synergistic effect is the effect of two drugs being greater than the effect of each chemical individually or the sum of the individual effects. Carcinogenicity is the ability of a drug to cause cells to mutate and become cancerous.

DIF: Cognitive Level: Knowledge

REF: p. 19

OBJ: 6

NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

CON: Safety | Patient Education

5. What do drug blood levels indicate? a. They confirm if the patient is taking a generic form of a drug. b. They determine if the patient has sufficient body fat to metabolize the drug. c. They verify if the patient is taking someone else‘s medications. d. They determine if the amount of drug in the body is in a therapeutic range.

ANS: D

The amount of drug present may vary over time and the blood level must remain in a therapeutic range in order to obtain the desired result. Generic drugs do not necessarily produce a different drug blood level than proprietary medications. Body fat is not measured by drug blood levels. Drug blood levels only measure the amount of drug in the body; they do not determine the source of the medication.

DIF: Cognitive Level: Comprehension REF: p. 17 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety 6. What is the process by which a drug is transported by circulating body fluids to receptor sites? a. Osmosis b. Distribution c. Absorption d. Biotransformation ANS: B

Distribution refers to the ways in which drugs are transported by the circulating body fluids to the sites of action (receptors), metabolism, and excretion. Osmosis is the process of moving solution across a semipermeable membrane to equalize the dilution on each side. Absorption is the process by which a drug is transferred from its site of entry into the body to the circulating fluids for distribution. Biotransformation, also called metabolism, is the process by which the body inactivates drugs.

DIF: Cognitive Level: Knowledge REF: p. 15 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Patient Education | Clinical Judgment | Safety 7. Which blood level is assessed to determine the amount of circulating medication in a patient? a. Peak b. Trough c. Drug d. Therapeutic ANS: C

When a drug is circulating in the blood, a blood sample may be drawn and assayed to determine the amount of drug present; this is known as the drug blood level. Peak levels are only those drug blood levels that are at their maximum before metabolism starts to decrease the amount of circulating drug. Trough levels are only those drug blood levels that are at their minimum when metabolism has decreased the amount of circulating drug and before an increase caused by a subsequent dose of the medication. Therapeutic levels are only those within a prescribed range of blood levels determined to bring about effective action of the medication.

DIF: Cognitive Level: Knowledge REF: p. 17 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Patient Education | Clinical Judgment | Safety 8. The nurse administers 50 mg of a drug at 6:00 AM that has a half-life of 8 hours. What time

will it be when 25 mg of the drug has been eliminated from the body? a. 8:00 AM b. 11:00 AM c. 2:00 PM d. 6:00 PM ANS: C

Fifty percent of the medication, or 25 mg, will be eliminated in 8 hours, or at 2:00 PM. 8:00 AM is 2 hours after administration; the half-life is 8 hours. 11:00 AM is 4 hours after administration; the half-life is 8 hours. 6:00 PM is 12 hours after administration; the half-life is 8 hours.

DIF: Cognitive Level: Analysis REF: p. 16 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety | Elimination | Health Promotion 9. What will the nurse need to determine first in order to mix two drugs in the same syringe? a. Absorption rate of the drugs b. Compatibility of the drugs c. Drug blood level of each drug d. Medication adverse effects ANS: B

Knowledge of absorption is important but not in order to mix drugs. In order to mix two drugs, compatibility is determined so there is no deterioration when the drugs are mixed in the same syringe. Drug level does not indicate if it is acceptable to mix medications in the same syringe. Adverse effects are important for the nurse to know but not in order to mix drugs.

DIF: Cognitive Level: Application REF: p. 19 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 5 CON: Clinical Judgment | Safety

10. A patient developed hives and itching after receiving a drug for the first time. Which

instruction by the nurse is accurate? a. Stop the medication and encourage the patient to wear a medical alert bracelet that explains the allergy.

b. Explain to the patient that these are signs and symptoms of an anaphylactic

reaction. c. Emphasize to the patient the importance to inform medical personnel that in the

future a lower dosage of this drug is necessary. d. Instruct the patient that it would be safe to take the drug again because this

instance was a mild reaction.

ANS: A

This initial allergic reaction is mild, and the patient is more likely to have an anaphylactic reaction at the next exposure; a medical alert bracelet is necessary to explain the reaction.

Signs and symptoms of an anaphylactic reaction are respiratory distress and cardiovascular collapse. A more severe reaction will occur at the next exposure, and the patient should not receive the drug again.

DIF: Cognitive Level: Application REF: p. 18 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Patient Education | Clinical Judgment | Safety

OBJ: 4

11. Which assessment data would the nurse identify as having the most effect on drug

metabolism? a. History of liver disease b. Intake of a vegetarian diet c. Sedentary lifestyle d. Teacher as an occupation ANS: A

Liver enzyme systems are the primary site for metabolism of drugs. Intake of a vegetarian diet may affect absorption but not metabolism. Sedentary lifestyle and occupations could affect metabolism (exposure to environmental pollutants), but these do not have the most significant effect on metabolism.

DIF: Cognitive Level: Comprehension REF: p. 15 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Patient Education | Clinical Judgment | Safety 12. A physician‘s order indicates to administer a medication to the patient via the percutaneous

route. Which route will the nurse anticipate the patient will receive this medication? a. Intramuscularly b. Subcutaneously c. Topically d. Rectally ANS: C

The percutaneous route refers to drugs that are absorbed through the skin and mucous membranes. Methods of the percutaneous route include inhalation, sublingual (under the tongue), or topical (on the skin) administration. The parenteral route bypasses the gastrointestinal (GI) tract by using subcutaneous (subcut), intramuscular (IM), or intravenous (IV) injection. The parenteral route bypasses the GI tract by using subcut, IM, or IV injection.

In the enteral route, the drug is administered directly into the GI tract by the oral, rectal, or nasogastric route.

DIF: Cognitive Level: Comprehension REF: p. 14 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Patient Education | Clinical Judgment | Safety

OBJ: 1

13. Which medication should not be administered with tetracycline? a. Ativan b. Tylenol c. Colace d. Mylanta ANS: D

Administering tetracycline with Mylanta can provide an antagonistic effect that will result in decreased absorption of the tetracycline. Ativan, Tylenol, and Colace are not contraindicated to administer with tetracycline.

DIF: Cognitive Level: Comprehension REF: p. 18 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Patient Education | Clinical Judgment | Safety

OBJ: 5

MULTIPLE RESPONSE 1. Which statement(s) about liberation of drugs is/are true? (Select all that apply.) a. A drug must be dissolved in body fluids before it can be absorbed into body

tissues. b. A solid drug taken orally must disintegrate and dissolve in GI fluids to allow for

absorption into the bloodstream for transport to the site of action. c. The process of converting the drug into a soluble form can be controlled to a

certain degree by the dosage form. d. Converting the drug to a soluble form can be influenced by administering the drug

with or without food in the patient‘s stomach. e. Elixirs take longer to be liberated from the dosage form.

ANS: A, B, C, D

Regardless of the route of administration, a drug must be dissolved in body fluids before it can be absorbed into body tissues. Before a solid drug taken orally can be absorbed into the bloodstream for transport to the site of action, it must disintegrate and dissolve in the GI fluids and be transported across the stomach or intestinal lining into the blood. The process of converting a drug into a soluble form can be partially controlled by the pharmaceutical dosage form used (e.g., solution, suspension, capsules, and tablets with various coatings). The conversion process can also be influenced by administering the drug with or without food in the patient‘s stomach. Elixirs are already drugs dissolved in a liquid and do not need to be liberated from the dosage form.

DIF: Cognitive Level: Comprehension REF: p. 14 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Patient Education | Clinical Judgment | Safety 2. Which are routes of drug excretion? (Select all that apply.)

OBJ: 1 | 3

a. b. c. d. e.

GI tract, feces Genitourinary (GU) tract, urine Lymphatic system Circulatory system, blood/plasma Respiratory system, exhalation

ANS: A, B, E

The GI system is a primary route for drug excretion. The GU and the respiratory systems do function in the excretion of drugs. The lymphatic and circulatory systems are involved with drug distribution, not drug excretion.

DIF: Cognitive Level: Knowledge REF: p. 15 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Patient Education | Clinical Judgment | Safety | Elimination 3. Which route(s) enable(s) drug absorption more rapidly than the subcut route? (Select all that

apply.) a. IV route b. IM route c. Inhalation/sublingual d. Intradermal route e. Enteral route ANS: A, B, C

IV route of administration enables drug absorption more rapidly than the subcut route. IM route of administration enables drug absorption more rapidly because of greater blood flow per unit weight of muscle. Inhalation/sublingual route of administration enables drug absorption more rapidly than the subcut route. Intradermally administered drugs are absorbed more slowly because of the limited available blood supply in the dermis. Enterally administered drugs are absorbed more slowly because of the biotransformation process.

DIF: Cognitive Level: Knowledge REF: p. 14 OBJ: 1 | 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Patient Education | Clinical Judgment | Safety 4. Which factor(s) contribute(s) to digoxin toxicity in a 92-year-old patient? (Select all that

apply.) a. Taking the medication with meals b. Prolonged half-life of the drug digoxin c. Impaired renal function d. Diminished mental capacity ANS: B, C

Impaired renal and hepatic function in older adults impairs metabolism and excretion of drugs, thus prolonging the half-life of a medication. Food would decrease the absorption of the drug. Diminished mental capacity does not contribute to drug toxicity unless it is due to administration errors.

DIF: Cognitive Level: Comprehension REF: p. 15 OBJ: 2 | 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Patient Education | Clinical Judgment | Safety

5. Which statement(s) about variables that influence drug action is/are true? (Select all that

apply.) a. An older adult will require increased dosage of a drug to achieve the same therapeutic effect as that seen in a younger person. b. Body weight can affect the therapeutic response of a medication. c. Chronic smokers may metabolize drugs more rapidly than nonsmokers. d. A patient‘s attitude and expectations affect the response to medication. e. Reduced circulation causes drugs to absorb more rapidly.

ANS: B, C, D

Body weight can affect response to medications; typically, obese patients require an increase in dosage and underweight patients a decrease in dosage. Chronic smoking enhances metabolism of drugs. Attitudes and expectations play a major role in an individual‘s response to drugs. Older adults require decreased dosages of drugs to achieve a therapeutic effect.

Decreased circulation causes drugs to absorb more slowly.

DIF: Cognitive Level: Comprehension REF: p. 17 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Patient Education | Clinical Judgment | Safety

OBJ: 4

6. Which factor(s) affect(s) drug actions? (Select all that apply.) a. Teratogenicity b. Age c. Body weight d. Metabolic rate e. Illness ANS: B, C, D, E

Age, body weight, metabolic rate, and illness may contribute to a variable response to a medication. Teratogenicity does not contribute to a variable response to a medication.

DIF: Cognitive Level: Knowledge REF: p. 17 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Patient Education | Clinical Judgment | Safety COMPLETION 1. A patient receives 200 mg of a medication that has a half-life of 12 hours. How many mg of

the drug would remain in the patient‘s body after 24 hours? _____ ANS:

50 The half-life is defined as the amount of time required for 50% of the drug to be eliminated from the body. If a patient is given 200 mg of a drug that has a half-life of 12 hours, then 50 mg of the drug would remain in the body after 24 hours.

DIF: Cognitive Level: Analysis REF: p. 16 NAT: NCLEX Client Needs Category: Physiological Integrity

OBJ: 2

TOP: Nursing Process Step: Evaluation

CON: Clinical Judgment | Safety

Chapter 03: Drug Action Across the Life Span Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. What time will the trough blood level need to be drawn if the nurse administers the

intravenous medication dose at 9:00 AM? a. 6:30 AM b. 8:30 AM c. 9:30 AM d. 11:30 AM ANS: B

Trough blood levels measure the lowest blood level of medicine and are obtained just before the dose is administered. In this case, 6:30 AM is too early to obtain the blood level. The other two times occur after the medication is administered.

DIF: Cognitive Level: Application REF: p. 28 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 3 CON: Clinical Judgment | Safety

2. What will the nurse expect the healthcare provider‘s order to be when starting an older adult

patient on thyroid hormone replacement therapy? a. Administering a loading dose of the drug b. Directions on how to taper the drug c. A dosage that is one-third to one-half of the regular dosage d. A dosage that is double the regular dosage ANS: C

To prevent toxicity, dosages for new medications in older adults should be one-third to one-half the amount of a standard adult dosage. Loading doses of drugs could cause severe toxicity. Tapering off is characteristic of discontinuation of medications and is not appropriate for this situation. Older adults generally need a lower medication dosage than younger patients.

DIF: Cognitive Level: Comprehension REF: p. 31 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education | Development 3. Which drugs cause birth defects? a. Teratogens b. Carcinogens c. Metabolites d. Placebos ANS: A

Teratogens are drugs that cause birth defects. Carcinogens cause cancer. Metabolites are the end product of metabolism. Placebos are drugs that have no pharmacologic activity.

DIF: Cognitive Level: Knowledge REF: p. 31 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Patient Education | Development 4. Which life-threatening illness may occur as a result of aspirin (salicylate) administration

during viral illness to patients younger than 20 years of age? a. Anaphylactic shock b. Reye‘s syndrome c. Chickenpox d. Influenza A ANS: B

Children are susceptible to Reye‘s syndrome if they ingest aspirin at the time of or shortly after a viral infection of chickenpox or influenza. Anaphylactic shock is caused by a hypersensitivity reaction. Chickenpox is the result of being infected with a virus. Influenza A is caused by a pathogen.

DIF: Cognitive Level: Knowledge REF: p. 30 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education | Development 5. Which classification of medications commonly causes allergic reactions in children? a. Antacids b. Analgesics c. Antibiotics d. Anticonvulsants ANS: C

Antibiotics, especially penicillins, commonly cause allergic reactions in children. Intravenous antibiotics can cause rapid reactions; therefore, the pediatric patient‘s response to a medication should be assessed and monitored closely. Antacids rarely cause allergic reactions.

Children are not particularly allergic to analgesics or anticonvulsants.

DIF: Cognitive Level: Knowledge REF: p. 29 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Patient Education | Development 6. Which patient statement indicates the need for further teaching after giving instructions to an

expectant mother about taking medications during pregnancy? a. ―I will not take herbal medicines during pregnancy.‖ b. ―For morning sickness, I will try crackers instead of taking a drug.‖ c. ―If I get a cold, I will avoid taking nonprescription medications until I check with my physician.‖ d. ―I will limit my alcohol intake to only one glass of wine weekly.‖ ANS: D

Alcohol needs to be eliminated during pregnancy and for 2 to 3 months prior to conception.

Limited studies are available regarding the use of herbal medications in general, and thus they should be avoided during pregnancy. Alternative nonpharmacologic treatments are appropriate to use during morning sickness. The pregnant woman should also avoid using nonprescription drugs because few data are available about safe use in pregnancy. Because few medicines can be considered completely safe for use in pregnancy, the physician needs to approve and recommend the use of nonprescription drugs.

DIF: Cognitive Level: Application REF: p. 34 OBJ: 6 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education 7. When is the ideal time for a nursing mother to take her own medications? a. Before the infant latches on to begin to breastfeed. b. As soon as the mother wakes up in the morning. c. Right before the mother goes to sleep at night. d. As soon as the infant finishes breastfeeding.

ANS: D

Taking medications after breastfeeding reduces the amount of the medication that will reach the baby. Medications taken directly before breastfeeding may have a high concentration in the milk and possibly pass on to the baby. The mother must take into consideration when her medications are ordered to be taken and schedule them around breastfeeding.

DIF: Cognitive Level: Comprehension REF: p. 34 OBJ: 6 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education 8. Which age-related change would affect transdermal drug absorption in geriatric patients the

most? a. Difficulty swallowing b. Diminished kidney function c. Changes in pigmentation d. Altered circulatory status ANS: D

The decreased circulation that occurs with aging will affect transdermal drug absorption.

Difficulty swallowing would not affect transdermal drugs being absorbed. Kidney function affects drug excretion. Changes in pigmentation would not affect transdermal drug absorption.

DIF: Cognitive Level: Comprehension REF: p. 25 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Patient Education | Development 9. Which intervention would be considered to reduce accumulation of a drug in a patient who

has decreased liver function? a. Decreasing the time interval between dosages b. Reducing the dosage c. Administering the medication intravenously

d. Changing the drug to one that has a longer half-life ANS: B

Dosages must be reduced to prevent accumulation. Decreasing the time interval between dosages would increase the accumulation of the drug. The intravenous route has the fastest absorption and with liver dysfunction would increase the accumulation of the drug. A similar drug with a longer half-life would stay in the system longer; with impaired liver function, the result would be increased accumulation.

DIF: Cognitive Level: Comprehension REF: p. 26 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Safety | Patient Education | Health Promotion 10. Which explanation by the nurse is most helpful when teaching an elderly patient with

difficulty swallowing about medications? a. ―Enteric coated tablets can be crushed and taken with applesauce.‖ b. ―Tablets that are scored can be broken in half.‖ c. ―Medications labeled ‗SR‘ can be crushed.‖ d. ―Avoid taking medications in liquid form.‖ ANS: B

It is acceptable to break scored tablets in half to facilitate swallowing of the medication.

Enteric coated tables should never be crushed because of the effect on the absorption rate and potential for toxicity. Medications labeled ―SR‖ indicate ―sustained release‖ and should not be crushed because of the effect on the absorption rate. Medication in liquid form may be easier to swallow.

DIF: Cognitive Level: Application REF: p. 31 OBJ: 4 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education 11. Which blood level determines the lowest amount of medication present in the patient? a. Peak b. Serum c. Therapeutic d. Trough ANS: D

The lowest amount of a medication in the blood is the trough. The peak is the highest amount of medication in the blood. Serum level identifies the amount of medication present.

Therapeutic levels identify the range in which a medication is effective.

DIF: Cognitive Level: Knowledge REF: p. 28 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 12. Which patient would the nurse identify as having the lowest rate of absorption of enteral

medications? a. A 5-year-old boy b. An 18-year-old woman

c. A 55-year-old man d. An 85-year-old woman ANS: A

Males‘ stomachs empty more rapidly; children have increased motility, resulting in decreased absorption time. As one gets older, gastrointestinal (GI) motility is decreased, allowing for increased absorption time; women have slower gastric emptying, resulting in more time for absorption. Males‘ stomachs empty more rapidly; however, as one gets older, GI motility is decreased, resulting in an increase in absorption time. As one gets older, GI motility is decreased, allowing for increased absorption time; women have slower gastric emptying, resulting in more time for absorption.

DIF: Cognitive Level: Comprehension REF: p. 24 | p. 25 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Development 13. What is the definition of cumulative effect of a drug? a. Drug toxicity related to overmedication b. Drug buildup related to decreased metabolism c. The inability to control the ingestion of drugs d. The need for higher dosage to produce the same effect as previous lower dosages ANS: B

Cumulative effects are related to diminished metabolism or excretion of a drug that causes it to accumulate. Cumulative effects can lead to drug toxicity. Toxicity occurs when adverse effects are severe. Inability to control the ingestion of drugs is drug dependence. The need for higher dosage to produce the same effect as previous lower dosages is the definition of tolerance.

DIF: Cognitive Level: Knowledge REF: p. 24 | p. 25 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 14. Which patient, when compared with the general population, would require a larger dose or

more frequent administration of a drug to attain a therapeutic response? a. A 29 year old who has been diagnosed with kidney failure b. A 35-year-old obese male who is being evaluated for an exercise program c. A 52 year old diagnosed with hypothyroidism and decreased metabolic rate d. A 72 year old with decreased circulatory status ANS: B

An obese individual would require a larger dose of a drug to attain a therapeutic response. An individual with kidney failure would require less medication because of decreased excretory ability. Individuals with decreased metabolic rate would metabolize drugs more slowly and require smaller doses or less frequent administration. Individuals with decreased circulation would require less medication.

DIF: Cognitive Level: Comprehension REF: p. 22 | p. 23 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Health Promotion

15. Which action should the nurse implement when a resident in a long-term care facility reports

difficulty swallowing enteric coated aspirin and asks the nurse to crush it prior to administration? a. Crush the tablet and mix with applesauce. b. Encourage the resident to swallow the tablet with a full glass of water. c. Hold the medication and notify the physician. d. Substitute a regular aspirin for the enteric coated tablet.

ANS: C

The medication should be held and the physician notified. The physician has the authority to determine how to proceed in this situation. Enteric coated tablets should not be crushed because this will increase the absorption rate and the potential for toxicity. Geriatric patients may have difficulty swallowing and are at risk for choking and aspiration. They should not be encouraged to swallow medications if they report difficulty swallowing. The physician must determine if a substitution can be ordered. Prescribing is not in the nurse‘s scope of practice.

DIF: Cognitive Level: Application REF: p. 25 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education

OBJ: 3

MULTIPLE RESPONSE 1. One of the prescribed medications for a 36-week gestational age baby girl is a topical

water-soluble medication to be applied to the perineum daily to treat an inflammatory rash.

Which considerations is the nurse aware of before medication administration? (Select all that apply.) a. Age of the client b. Location of topical application c. Increased intestinal transit rate d. Condition of the skin e. Gastric pH of 8 ANS: A, B, D

The premature infant‘s outer layer of skin is not fully developed, although it is more hydrated, which will enhance the absorption of the topical water-soluble medication. Neonates often wear diapers, which will act as an occlusive dressing, thereby increasing absorption. The client‘s inflammatory condition will increase the absorption of medication. The intestinal transit rate increases as the newborn matures. This is irrelevant when a medication is applied topically. Gastric pH would not factor into metabolism of a medication that is applied topically.

DIF: Cognitive Level: Comprehension REF: p. 25 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Development

OBJ: 3

2. The nurse is caring for a 4-month-old child who is on a water-soluble medication for seizures.

The child‘s mother voices concern that the dosage seems ―too much‖ for the child‘s age and would like the dosage verified. What actions will the nurse take? (Select all that apply.) a. Verify dosage requirements in the Physicians’ Desk Reference (PDR) in mg/kg.

b. c. d. e.

Compare the water composition requirements of adults and children.

Evaluate lean body mass and total fat content in adults and infants.

Chart ―refused per mother‖ on the MAR and do not administer.

Compare transportation in the circulation of plasma bound proteins between adults and children.

ANS: A, B

The PDR lists the recommended dosages for all age-groups. Because dilution may vary among age-groups, the water concentration should be verified prior to administration. As we age, lean body mass and total body water decrease while total fat content increases; however, this drug is not fat soluble. The nurse is responsible for administering the medication as ordered after verifying that it is correct; the mother is asking for verification, not refusal of administration. Drugs that are relatively insoluble are transported in the circulation by being bound to plasma proteins; however, this drug is water soluble.

DIF: Cognitive Level: Application REF: p. 29 | p. 30 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education | Development 3. Which reason(s) explains why elderly patients are at increased risk for drug interactions and

toxicity? (Select all that apply.) a. Higher incidence of malnourishment b. Renal function is enhanced c. Increased use of multiple medications d. Hepatic function is reduced e. Issues with swallowing ANS: A, C, D

Older adult patients have an increased incidence of malnourishment, are often on multiple medications, and have reduced hepatic function, all of which put them at increased risk for drug interactions and toxicity. Renal function diminishes in the elderly as a result of decreased renal blood flow, reduced cardiac output, loss of glomeruli, and diminished tubular function and concentrating ability. Older adults have swallowing difficulties, leading to compliance issues, but taking drugs less often would not result in toxicity.

DIF: Cognitive Level: Comprehension REF: p. 30 | p. 31 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Patient Education | Development 4. Which patient(s) require(s) special considerations for medication administration? (Select all

that apply.) a. A 29-year-old pregnant woman b. A 2-month-old baby c. An 18-year-old college student d. A 45-year-old farmer e. An 82-year-old retired nurse ANS: A, B, E

Drug therapy during pregnancy should be avoided. Recommendations by the provider are necessary during any stage of pregnancy. Pediatric and elderly patients are affected by differences in muscle mass and blood flow to muscles, as well as other physiologic systems.

Teenagers and adult patients do not typically require special considerations for medication administration.

DIF: Cognitive Level: Comprehension REF: p. 22-24 OBJ: 3 | 6 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Safety | Development 5. Which factor(s) in a patient would influence GI absorption of medications? (Select all that

apply.) a. Stomach pH b. Level of consciousness c. Fever d. Blood flow to gastric mucosa e. Weight f. Body surface area ANS: A, D

Absorption by passive diffusion across the membranes depends on the pH of the environment.

Increased blood flow to gastric mucosa increases absorption of medication and decreases time of absorption. Drug absorption does not depend on the mental status of the patient. Fever does not affect drug absorption. The patient‘s absolute weight and body surface area do not affect drug absorption, although problems associated with weight greater than or less than normal may be a factor in the process.

DIF: Cognitive Level: Comprehension REF: p. 24 | p. 25 | p. 28 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 6. When receiving a report on a new admission from the emergency room, the nurse learns that

the patient is newly diagnosed with renal failure. Which medication(s) in the patient‘s medication history will require dosage adjustment by the physician? (Select all that apply.) a. Lithium b. Tobramycin c. Atenolol d. Quinidine e. Ampicillin ANS: A, B, C, D, E

Lithium, tobramycin, atenolol, quinidine, and ampicillin are all select medications that require dosage adjustment in renal failure.

DIF: Cognitive Level: Comprehension REF: p. 27 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Patient Education 7. Which information should be relayed when providing prenatal education at a maternal family

child clinic? (Select all that apply.) a. Herbal medicines are considered safe.

b. c. d. e.

Limit tobacco consumption to less than two cigarettes per day.

Encourage a folic acid supplement.

One alcoholic beverage per day is acceptable in the last trimester.

Encourage nonpharmacologic treatments for symptoms such as nausea.

ANS: C, E

Good nutrition with appropriate ingestion of vitamins (especially folic acid) is particularly important during pregnancy to prevent birth defects. Before using medicines, pregnant women should be encouraged to try nonpharmacologic treatments. Herbal medicines that have not been scientifically tested in women during pregnancy should be avoided. Advise against the use of tobacco. Mothers who smoke have a higher frequency of miscarriage, stillbirths, premature births, and low-birth-weight infants. Consumption of alcohol should be eliminated 2 to 3 months before planned conception, as well as during pregnancy.

DIF: Cognitive Level: Application REF: p. 31 | p. 32 OBJ: 6 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education

Chapter 04: The Nursing Process and Pharmacology Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. What is the primary purpose of the nursing assessment? a. Identifying underlying pathologic conditions b. Assisting the physician in identifying medical conditions c. Determining the patient‘s mental status d. Exploring patient responses to health problems ANS: D

A nursing assessment is done to identify the patient‘s response to health problems. During the nursing assessment phase, a comprehensive information base is developed through a physical examination, nursing history, medication history, and professional observation. Identifying underlying pathologic conditions and assisting the physician in identifying medical conditions is not part of the nursing process. Determining the patient‘s mental status is one part of the nursing assessment, but it is not the primary purpose.

DIF: Cognitive Level: Comprehension REF: p. 39 OBJ: 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Health Promotion | Care Coordination | Collaboration 2. What is the basis of the NANDA-I taxonomy? a. Functional health patterns b. Human response patterns c. Basic human needs d. Pathophysiologic needs ANS: B

The NANDA-I taxonomy identifies human response patterns. Functional components of health patterns are limited to activity, fluid volume, nutrition, self-care, and sensory perception. Basic human needs comprise less than merely health patterns. Pathophysiologic needs are not part of the scope of NANDA-I. DIF: Cognitive Level: Knowledge REF: p. 40 | p. 41 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Diagnosis CON: Clinical Judgment | Health Promotion 3. Which task is included in the assessment step of the nursing process? a. Establishing patient goals/outcomes b. Implementing the nursing care plan (NCP) c. Measuring goal/outcome achievement d. Collecting and communicating data ANS: D

Data are collected and communicated in the assessment phase of the nursing process.

Establishing goals is the function of planning. Implementing the NCP is the function of implementation. Measuring outcome achievement is the function of evaluation.

DIF: Cognitive Level: Comprehension REF: p. 39 OBJ: 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment 4. Which statement regarding nursing diagnoses is accurate? a. Nursing diagnoses remain the same for as long as the disease is present. b. Nursing diagnoses are written to identify disease states. c. Nursing diagnoses describe patient problems that nurses treat. d. Nursing diagnoses identify causes related to illness.

ANS: C

Diagnostic statements identify problems a nurse is independently able to treat within the scope of professional practice. Nursing diagnoses vary with the changing condition of the patient.

The response patterns are unique to the patient and are not disease specific. Nursing diagnoses describe the patient‘s human response pattern.

DIF: Cognitive Level: Comprehension REF: p. 41 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Diagnosis CON: Clinical Judgment 5. Which phase of the nursing process occurs when the nurse analyzes data and identifies certain

major and minor defining characteristics then relate them to a particular patient problem? a. Assessment b. Diagnosis c. Planning d. Evaluation ANS: B

The nurse analyzes the data collected during the assessment phase This analysis determines which data is important to act on and which data is to be monitored. The nurse may conclude that certain actual problems are present and identifies them with a nursing diagnosis. Planning occurs after the patient has been assessed and problems have been diagnosed concluding with plans being formed to meet patient needs. Evaluation involves the nurse determining whether the expected outcomes were met.

DIF: Cognitive Level: Knowledge REF: p. 41 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Health Care Organizations 6. Which type of nursing diagnosis will be written when the patient exhibits factors that make

him or her susceptible to the development of a problem? a. Actual diagnosis b. Risk diagnosis c. Possible diagnosis d. Wellness diagnosis ANS: B

When patients have the potential or risk for a problem to develop, a risk diagnosis is written.

These diagnoses are two-part statements such as risk for falls related to unsteady gait. An actual diagnosis consists of a NANDA diagnostic label, contributing factor (if known), and defining characteristics such as signs and symptoms. A possible nursing diagnosis identifies a problem that may occur, but the assembled data are insufficient to confirm it. A wellness diagnosis applies to individuals for whom an enhanced level of wellness is possible.

DIF: Cognitive Level: Comprehension REF: p. 41 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Diagnosis CON: Health Promotion 7. Which outcome statement identified by the nurse is written correctly? a. After surgery, patient will express acceptance of loss of breast. b. Patient will die with dignity. c. At the end of the shift, the nurse will determine whether the patient is more

comfortable. d. Within the next 8 hours, urine output will be greater than 30 mL/hr.

ANS: D

The statement, ―Within the next 8 hours, urine output will be greater than 30 mL/hr‖ is patient oriented, realistic, and measurable, and has an appropriate time frame.

DIF: Cognitive Level: Application REF: p. 42 | p. 43 OBJ: 6 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Evaluation CON: Clinical Judgment 8. Which is an example of an interdependent nursing action? a. Assess lung sounds every 4 hours. b. Educate the patient about the prescribed medication. c. Administer Demerol 50 mg intramuscularly (IM) every 4 hours PRN. d. Encourage the patient to express feelings.

ANS: C

―Administer Demerol 50 mg IM every 4 hours PRN‖ requires the nurse to follow the parameters of the order, yet use nursing judgment to determine how often the medication is to be administered; therefore, it is an interdependent nursing action. Assessing lung sounds, educating the patient about medication, and encouraging the patient to express feelings are independent nursing actions.

DIF: Cognitive Level: Application REF: p. 44 OBJ: 8 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment 9. What is the nurse‘s primary source of information when obtaining a patient history? a. The physician b. The patient record c. The family d. The patient ANS: D

The focus of the nursing process is the patient. Although family members contribute to the nursing history, this information is secondhand. It is important that the nurse continue to assess patient data for validation of this information. The physician is not to be relied on to provide information about a complete patient history. The patient record reflects only recorded past information and not current input that may be relevant. The family may provide information about a patient history if the patient is unable to provide it, but the information is subject to interpretation by someone other than the patient.

DIF: Cognitive Level: Knowledge REF: p. 39 | p. 40 OBJ: 2 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Clinical Judgment 10. An obese patient did not meet the goal of ―by the end of the second week, is able to follow a

1500 calorie diet.‖ What will the nurse and the patient reassess? a. Patient‘s weight b. Patient‘s understanding of the 1500 calorie diet c. Nurse‘s feelings about obese patients d. Healthcare agency‘s ability to provide the prescribed diet ANS: B

When goals are not met, the nurse must reassess the patient‘s understanding of the interventions and commitment to reaching the identified goal. All phases of the nursing process are ongoing as the nurse continues to evaluate, assess, and readjust interventions as indicated to facilitate patient achievement of outcomes. The patient may have followed the diet but not lost any weight. The nurse‘s feelings should not be a factor in the assessment. The agency‘s ability to provide the prescribed diet should have been determined before implementation of the plan.

DIF: Cognitive Level: Analysis REF: p. 42 | p. 43 OBJ: 1 | 6 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Patient Education 11. What is a critical care pathway? a. Nursing care plan for a patient in a critical care unit

b. Standardized care plan derived from best practice patterns c. Care plan that has been critiqued by a quality improvement officer d. Care plan based on measurable goals and outcomes ANS: B

A critical care pathway is a standardized care plan derived from best practice patterns, enabling the nurse to develop a treatment plan that sequences detailed clinical interventions to be performed over a projected amount of time for a specific case type of disease process. A nursing care plan for a patient in a critical care unit is not a critical care pathway. A care plan that has been critiqued by a quality improvement officer is not a critical care pathway. All good care plans are based on measurable goals and outcomes.

DIF: Cognitive Level: Knowledge REF: p. 45 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment 12. When a nursing diagnosis statement is written, who or what directs the nurse to identify

appropriate nursing interventions? a. Other nurses on staff who have experience with the diagnoses b. The patient and family who have an interest in the outcome c. The etiologies of the problems identified in the nursing diagnoses d. The medical staff who have more expertise than the nurses ANS: C

Nursing actions are suggested by the etiologies of the problems identified in the nursing diagnoses and are used to implement plans. Nursing actions are not suggested by other nurses, the patient and family, or by the medical staff.

DIF: Cognitive Level: Comprehension REF: p. 42 OBJ: 6 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment 13. Which information obtained by the nurse is subjective when a patient experiences adverse

effects of a medication? a. Cough b. Edema c. Nausea d. Tachycardia ANS: C

Nausea is a symptom for which only the person experiencing it can provide the information.

Cough is heard by the nurse. Edema is measured and seen by the nurse. Tachycardia is assessed by the nurse.

DIF: Cognitive Level: Application REF: p. 40 | p. 41 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 14. Which step of the nursing process is being used when it has been determined that the pain

medication given to patient an hour ago has been effective? a. Evaluation b. Intervention

c. Nursing diagnosis d. Planning ANS: A

The nurse has used evaluation to assess the response to the administered medication.

Intervention is the administration of the medication or teaching about the medication in this situation. This situation is not an example of making a nursing diagnosis. Planning is developing goal statements and prioritizing patient problems.

DIF: Cognitive Level: Application REF: p. 39 | p. 40 OBJ: 1 | 6 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment 15. Which step of the nursing process is being used when prior to the administration of a

nephrotoxic drug, the nurse determines that the kidney lab data are within normal range? a. Assessment b. Nursing diagnosis c. Planning d. Evaluation ANS: A

The nurse is collecting information about renal function through lab data; this is baseline assessment data. This action is not an example of the development of a nursing diagnosis.

Planning is developing goal statements and prioritizing patient problems. Evaluation determines if goals have been met.

DIF: Cognitive Level: Application REF: p. 44 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 16. Which statement best describes the planning phase of the nursing process? a. Administer insulin subcutaneously (subcut) in the abdominal area. b. Patient is at high risk for falls related to hypotension. c. The patient will state the expected adverse effects of medication by the end of the

teaching session. d. Itching has resolved; medication given is effective.

ANS: C

―The patient will state the expected adverse effects of medication by the end of the teaching session‖ is an example of a goal statement that is developed in the planning phase.

Administration of insulin subcut is an example of the implementation phase. Noting a high risk for falls related to hypotension is an example of the second phase or nursing diagnosis.

Stating that the medication given is effective is an example of the evaluation phase.

DIF: Cognitive Level: Application REF: p. 39 OBJ: 1 | 6 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment 17. The nurse is prioritizing care of a pediatric patient diagnosed with cystic fibrosis. Which

patient problem would the nurse consider the highest priority? a. Decreased appetite b. Thickened mucus secretions

c. Lack of knowledge about the disease process d. Decreased mobility ANS: B

Thickened mucus secretions lead to an altered breathing pattern therefore would be the highest priority because the physiologic need of oxygenation is required for total body function. Decreased appetite, lack of knowledge, and decreased mobility would not be of higher priority than oxygenation.

DIF: Cognitive Level: Analysis REF: p. 41 | p. 42 OBJ: 7 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Diagnosis CON: Clinical Judgment | Safety | Health Promotion 18. Rank the patient needs according to Maslow‘s hierarchy, beginning with the lowest level need

to the highest level need. a. A patient would like to write a book. b. A patient becomes frightened when no one answers the call light during the night. c. A pediatric patient is worrying that school friends will forget him. d. A patient needs to be repositioned in bed. e. A chronically ill patient states that he feels worthless because he is unable to support his family. a. e, b, a, c, d b. d, b, c, e, a c. d, e, b, a, c d. e, a, c, d, b ANS: B

The needs should be addressed in the following order: the patient‘s need for repositioning represents a basic need for comfort; the patient‘s alarm when the call light is not answered represents fear for safety; the patient‘s worry about his school friends forgetting him represents a threat to sense of love and belonging; the patient‘s feeling of worthlessness represents threatened self-esteem; and the patient‘s desire to write a book is related to self-actualization.

DIF: Cognitive Level: Analysis REF: p. 42 | p. 43 OBJ: 7 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Care Coordination | Health Promotion MULTIPLE RESPONSE 1. Which statement(s) regarding critical pathways is/are true? (Select all that apply.) a. Efficient for specific diseases or case types b. The same as medical plans c. Standardized and enhanced quality care d. Evaluated less frequently than care plans e. Enhanced communication for a variety of healthcare providers ANS: A, C, E

Critical pathways are standardized care plans that detail clinical interventions to be performed over a projected time frame for a specific disease or case type. Physician interventions are included in the pathways. Critical pathways enhance the quality of care and require evaluation and modification on an ongoing basis. Critical pathways assist as a communication system for all healthcare providers. Medical plans are distinct to physicians. Critical pathways should be evaluated as needed to achieve desired outcomes.

DIF: Cognitive Level: Comprehension REF: p. 42 OBJ: 1 | 5 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Planning CON: Clinical Judgment 2. Which explanation indicates the difference between a nursing diagnosis and a medical

diagnosis? (Select all that apply.) a. Statement of the patient‘s alterations in structure and functions b. Description of the patient‘s ability to function in relation to impairment c. Tend to remain the same throughout the course of illness or recovery from injury d. Varies depending on patient‘s state of recovery e. Based on research done by nurses f. Conditions can be accurately identified by nursing assessment methods ANS: B, D, E, F

Nursing diagnoses, as exemplified by the NANDA-I taxonomy, are statements about the patient‘s ability to function in relation to an illness or injury, vary with the patient‘s state of recovery, are based on research done by nurses, and can be determined based on nursing assessment methods. Nursing diagnoses do not include statements of the patient‘s alterations in structure and function and do not remain the same throughout the course of illness or recovery from injury.

DIF: Cognitive Level: Comprehension REF: p. 41 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 3. Which action will the nurse take when formulating a plan to meet the patient‘s needs in the

planning phase of the nursing process for a new admission to a long-term care facility? (Select all that apply.) a. Formulate nursing interventions. b. Collect data. c. Make a clinical judgment about the patient. d. Set priorities. e. Develop measurable goals.

ANS: A, D, E

Planning is the third phase of the five-step nursing process. Once the patient has been assessed and problems have been diagnosed, plans should be formulated to meet the patient‘s needs.

Planning usually encompasses four phases: (1) priority setting, (2) development of measurable goal and outcome statements, (3) formulation of nursing interventions, and (4) formulation of anticipated therapeutic outcomes that can be used to evaluate the patient‘s status. Collecting data is part of the assessment phase of the nursing process. Making a clinical judgment about the patient takes place during the diagnosis phase.

DIF: Cognitive Level: Application

REF: p. 41 | p. 42

OBJ: 1 | 6

NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Care Coordination | Health Promotion 4. Which intervention(s) will the nurse perform to ensure safety when preparing a patient‘s

prescribed medications? (Select all that apply.) a. Select the correct supplies. b. Administer the medication by the correct route. c. Use room number to identify correct patient. d. Educate patient regarding medications prescribed. e. Document in chart all aspects of medication administration.

ANS: A, B, D, E

The nurse prepares prescribed medications using procedures to ensure patient safety, including selecting correct supplies, administering medication by the correct route, educating patients regarding medications prescribed, and documenting in chart all aspects of medication administration. To improve the accuracy of patient identification, it is now recommended that two patient identifiers, neither of which is the room number, be used when administering medications. Best practice would be to look at the patient‘s name band for identity and to request that the patient state his or her name and birth date.

DIF: Cognitive Level: Application REF: p. 47 OBJ: 6 | 9 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Care Coordination

Chapter 05: Patient Education to Promote Health Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. The nurse is educating a 13-year-old boy newly diagnosed with diabetes and his parents about

diet and glucose monitoring. Which domain of learning is represented when the patient expresses concern about feeling different from his peers? a. Cognitive b. Psychomotor c. Affective d. Learning style ANS: C

The affective domain is characterized by conduct that expresses feelings, needs, beliefs, values, and opinions. The cognitive domain relates to basic factual knowledge. The psychomotor domain relates to kinesthetic knowledge, implemented in performance and skills requiring coordination. Learning style is not one of the three domains of learning.

DIF: Cognitive Level: Comprehension REF: p. 50 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Patient Education | Health Promotion

2. The nurse has taught a patient‘s spouse to administer an injectable medication. After the

spouse completed a return demonstration of the injection in the hospital, the nurse does not feel confident that this can be carried out independently at home and requests referral for a home health nurse. Which phase of the nursing process is being used? a. Assessment b. Implementation c. Planning d. Evaluation ANS: D

The nurse has evaluated the injection technique of the patient‘s spouse and determines additional instruction is needed. The nurse is not assessing the situation because she is not at the beginning of the process. The nurse is past implementation in the timeline of the process.

The nurse has already planned and implemented interventions.

DIF: Cognitive Level: Application REF: p. 52 OBJ: 5 | 6 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety | Patient Education | Health Promotion | Care Coordination 3. Which action is most appropriate when preparing for health teaching with a patient who has

an auditory learning style? a. Pamphlets from a pharmaceutical company b. Models of equipment used in a procedure c. Verbal description of the steps of a procedure d. A workbook with space to record actions and results ANS: C

Hearing the nurse present the information optimizes the patient‘s perception of the data.

Pamphlets from a pharmaceutical company or a workbook would be suitable for a patient who has a visual learning style. Models of equipment would be suitable for a patient with a psychomotor learning style.

DIF: Cognitive Level: Application REF: p. 51 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Patient Education | Communication 4. Which is the most intangible portion of the learning process? a. Cognitive b. Affective c. Psychomotor d. Eminent ANS: B

The affective domain concerns feelings, needs, beliefs, values, and opinions. The cognitive domain is the level at which basic knowledge is learned and stored; it is the thinking portion of the learning process. The psychomotor domain involves learning new procedures or skills; it is often referred to as the ―doing domain.‖ Eminent domain in common law legal systems is the lawful power of the state to expropriate private property without the owner‘s consent, either for its own use or on behalf of a third party.

DIF: Cognitive Level: Knowledge REF: p. 50 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Patient Education 5. Which would positively affect readiness to learn? a. Fear and denial b. Willingness to attain an optimal level of health c. Poor cognitive and motor development d. Lack of trust and confidence in the staff ANS: B

Readiness or the ability to engage in learning depends on motive, relevant preparatory learning, and physiologic maturation. In fear and denial, the patient is neither prepared nor willing to accept the limitations imposed by the disease process and learn to manage lifestyle changes. Poor cognitive and motor development handicap the patient‘s willingness and ability to learn. Trust is essential in the process of patient education. The patient must have confidence in the staff in order to be receptive to teaching efforts.

DIF: Cognitive Level: Comprehension REF: p. 52 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Patient Education 6. Which represents the psychomotor domain of learning? a. The patient draws up insulin in a syringe. b. The patient expresses a belief about medication use. c. The patient is able to verbalize foods that should be avoided. d. The patient relates past experience with smoking cessation.

ANS: A

The psychomotor domain involves the learning of a new procedure and is usually done by demonstration of the task. The patient expressing beliefs is an example of the affective domain. The patient verbalizing foods to be avoided is an example of the cognitive domain.

The patient relating past experiences is an example of the affective domain.

DIF: Cognitive Level: Comprehension REF: p. 51 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Patient Education 7. Which is an example of ethnocentrism? a. A 5-year-old Native American child colors in a book about diabetes. b. A 14-year-old African American attends a support group to learn about disease

management. c. A 36-year-old Asian prefers to take herbs instead of an oral medication. d. A 72-year-old Hispanic asks questions about potential adverse effects to a newly

prescribed medication.

ANS: C

Ethnocentrism is the assumption that one‘s culture provides the right way, and taking herbs instead of the medication exemplifies this belief. A 5-year-old Native American child coloring in a book about diabetes is an example of an age-appropriate learning process. A 14-year-old African American attending a support group to learn about disease management is an example of developmental impact on learning. A 72-year-old Hispanic person asking questions about potential adverse effects to a newly prescribed medication is demonstrating learning readiness.

DIF: Cognitive Level: Comprehension REF: p. 55 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Patient Education 8. Which nursing consideration is the most important when teaching an older adult patient about

a newly prescribed medication? a. Provide detailed information. b. Lengthen the time of each teaching session. c. Present information slowly. d. Limit discussion on the necessity of learning the information.

ANS: C

When teaching older adults, it is important to slow the pace of the presentation. Older adults process information more slowly because of limited short-term memory. Detailed information may be too overwhelming. The length of sessions should be limited for the older adult patient.

Adults need to understand why they must learn something before they undertake the effort to learn.

DIF: Cognitive Level: Comprehension REF: p. 54 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Patient Education | Communication 9. The nurse caring for a Spanish-speaking patient uses the assistance of an interpreter to help

with preoperative teaching. While implementing the education, the nurse should a. look directly at the patient. b. never use pantomime gestures. c. ask lengthy questions to provide clarity. d. ask a family member to assist with interpretation.

ANS: A

When using an interpreter, the nurse should look directly at the patient, not at the interpreter, while conversing. Sometimes supplementing questions with pictures and pantomime gestures may be helpful. The nurse should keep questions brief, asking them one at a time to give the interpreter an opportunity to rephrase the question and obtain a response. Whenever a third person enters into the communication cycle, lack of clarity and misinterpretation can occur.

DIF: Cognitive Level: Application REF: p. 55 NAT: NCLEX Client Needs Category: Psychological Integrity TOP: Nursing Process Step: Implementation CON: Health Promotion | Patient Education | Communication

OBJ: 2 | 4

10. Which action should be taken before initiating a teaching plan for the mother of a preterm

infant on prescribed medications?

a. b. c. d.

Recognize the individual‘s health beliefs.

Provide a formal learning setting.

Ensure that information is generalized.

Be sure that all care to the patient has been delivered.

ANS: A

Before initiating a teaching plan, the nurse must recognize the individual‘s health beliefs.

Teaching does not require a formal setting. Because health teaching requires the integration of the patient‘s beliefs, attitudes, values, opinions, and needs, an individualized teaching plan must be developed or a standardized teaching plan must be adapted to the individual‘s beliefs and needs. Some of the most effective teaching can be done while care is being delivered.

DIF: Cognitive Level: Application REF: p. 52 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education | Communication | Health Promotion MULTIPLE RESPONSE 1. Which item(s) would be considered characteristic of the cognitive domain level of learning?

(Select all that apply.) a. A patient‘s opinion regarding wellness b. Basic mathematical formulas learned in grade school c. Incorporation of a person‘s previous experiences and perceptions d. Skill demonstration using a step-by-step approach e. Relationship between prior experiences and new concepts ANS: B, C, E

Basic mathematical formulas learned previously, incorporating a person‘s previous experiences and perceptions, and a relationship between prior experiences and new concepts characterize the cognitive domain level of learning. A patient‘s opinion regarding wellness is an example of the affective domain. Skill demonstration using a step-by-step approach is an example of the psychomotor domain.

DIF: Cognitive Level: Comprehension REF: p. 50 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Patient Education | Communication 2. Which principle(s) of learning would be appropriate when preparing to instruct a patient and

his wife on technique and importance of assessing pulse prior to taking heart medication?

(Select all that apply.) a. The learning environment b. The patient‘s and wife‘s learning styles c. The objectives/goal statements listed on the patient‘s care plan d. The patient‘s financial ability to purchase the medication e. The patient‘s understanding of the seriousness of his illness ANS: A, B, C, E

Learning environment, learning style, listing clear objectives and goal statements, and understanding the seriousness of the situation are all principles of learning. Financial ability is not a principle of learning, but should be an important consideration and assessment when preparing for discharge of the patient and future compliance of the treatment regimen.

DIF: Cognitive Level: Application REF: p. 51 | p. 52 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Patient Education | Communication | Health Promotion 3. Which objective(s) is/are written in the correct format when writing a teaching plan for a

30-year-old patient who has AIDS? (Select all that apply.) a. The patient will state adverse effects of the daily medications before discharge. b. The patient will correctly fill the daily medication pillbox with the correct medications in the appropriate time slots prior to discharge. c. The patient will adjust the medications accordingly. d. The patient will schedule an appointment with the infectious disease physician before discharge. e. The patient will have lab tests performed regularly.

ANS: A, B, D

Each of correct objectives noted are measurable and specific.

DIF: Cognitive Level: Analysis REF: p. 51 | p. 52 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Patient Education 4. Which action(s) by the nurse can foster patient responsibility for adhering to the therapeutic

regimen? (Select all that apply.) a. Assessing the patient‘s readiness to learn b. Determining the patient‘s level of understanding of content c. Determining the patient‘s education level and learning style d. Maintaining an aloof attitude toward presented content e. Documenting expected outcomes independently ANS: A, B, C

The nurse should assess the patient‘s readiness to learn when teaching the patient. The nurse should determine the patient‘s level of understanding of the content and the patient‘s education level and learning style when teaching the patient. The nurse should portray a positive attitude when teaching the patient. Goals should be mutually written with the patient.

DIF: Cognitive Level: Comprehension REF: p. 57 OBJ: 4 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Patient Education | Care Coordination | Communication | Health Promotion 5. What should the nurse include during discharge in addition to verbal instructions? (Select all

that apply.) a. Written instructions for the patient‘s reference b. A phone number of the provider or hospital unit for follow-up questions c. Written instructions for monitoring of parameters used to evaluate therapy

d. Documentation in the nurse‘s discharge notes of the nursing and collaborative

problems that require continued monitoring and intervention e. Identification of the patient‘s unreasonable expectations of therapy ANS: A, B, C, D

Learning is an ongoing process. Verbal instructions should be followed up with instructions in writing. Patients should be given a contact number for future reference. Written instructions for monitoring of parameters used to evaluate therapy should be given to the patient.

Documentation is an essential part of validating the patient‘s understanding of the instructions provided. Although identifying the patient‘s expectations will affect the outcome, they are not part of the discharge planning documentation.

DIF: Cognitive Level: Application REF: p. 51 | p. 52 OBJ: 5 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Patient Education | Care Coordination | Communication | Health Promotion 6. Which action(s) would let the nurse know that the patient has mastered a psychomotor skill?

(Select all that apply.) a. Describe the process verbally. b. Write a description of the process. c. Give a reciprocal demonstration of the process. d. Ask questions about the process. e. Demonstrate the process to another person while the nurse supervises. f. State whether the patient feels the process has been mastered.

ANS: C, D

Having the patient demonstrate the process to the nurse or to another person is the best way to ensure that he can perform the skill correctly. Having the patient describe the process or write a description of the process is not sufficient. Asking questions may reinforce learning but may also mask some deficiencies. Asking the patient whether he feels he has mastered the process is not sufficient.

DIF: Cognitive Level: Comprehension REF: p. 52 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Patient Education | Care Coordination | Communication | Health Promotion 7. The nurse and patient are participating in cooperative goal setting regarding drug therapy.

Which task(s) is imperative to encourage the patient to perform? (Select all that apply.) a. Contact the hospital for advice regarding discontinuation of medication. b. Keep records of essential data needed to evaluate prescribed therapy. c. See the healthcare provider regularly. d. Avoid community-based agencies for assistance. e. Monitor parameters used to evaluate therapy.

ANS: B, C, E

An attitude of shared input into the goals and outcomes can encourage the patient into a therapeutic alliance. Therefore, the patient should be taught to help monitor the parameters used to evaluate therapy, keep records of essential data, and contact the healthcare provider for advice rather than alter or discontinue the medication entirely. The healthcare provider, not the hospital, should be contacted. In the event that the patient, family, or significant others do not understand all aspects of the continuing therapy prescribed, they may be referred to a community-based agency for help in achieving long-term healthcare requirements.

DIF: Cognitive Level: Application REF: p. 58 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Planning CON: Clinical Judgment | Patient Education | Care Coordination | Communication | Health Promotion

Chapter 06: Principles of Medication Administration and Medication Safety Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Where would the procedures and treatments directed by the healthcare provider be found? a. Summary sheet b. Physician‘s order form c. Physician‘s progress notes d. History and physical examination form ANS: B

The physician‘s order form contains all procedures and treatments ordered by the healthcare provider. A summary sheet provides a brief overview of the hospital course at discharge.

Physician‘s progress notes provide regular observations on the patient‘s course of treatment and response. A history and physical examination form provides information about baseline information from the patient.

DIF: Cognitive Level: Knowledge REF: p. 62 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Clinical Judgment 2. Which action will the nurse take when it is determined that the narcotic count is incorrect

while obtaining a medication from the narcotic area? a. Determine the cause of the discrepancy at the end of the shift. b. Notify the healthcare provider stat. c. Call the nurse from the previous shift to determine if there was a discrepancy earlier. d. Report the discrepancy to the charge nurse immediately.

ANS: D

Reporting the discrepancy to the charge nurse immediately enables the supervisory staff to narrow the time frame during which a medication was taken and not documented. The discrepancy needs to be addressed immediately, and therefore determining the cause of the discrepancy at the end of the shift is not the most appropriate action for the nurse to take. It is not appropriate to contact the healthcare provider for an incorrect narcotic count. The count would have been verified at shift change; calling the nurse from the previous shift is not an appropriate action for the nurse to take.

DIF: Cognitive Level: Application REF: p. 71 OBJ: 3 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety 3. Which action will the nurse take if a dosage is unclear on a healthcare provider‘s order? a. Ask the patient what dosage was given in the past. b. Ask another physician to determine the correct dosage. c. Tell the patient that the medication will not be given. d. Contact the healthcare provider to verify the correct dosage.

ANS: D

Any questionable orders should be verified by the healthcare provider who wrote the orders.

The patient is not a reliable source of verification. The physician who wrote the order should verify it. It would be a medication error to withhold the dose instead of verifying it.

DIF: Cognitive Level: Application REF: p. 74 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Safety 4. Which method is most reliable to calculate a pediatric patient‘s medication dosage? a. Age b. Height c. Body surface area (BSA) d. Placement on a growth scale ANS: C

The most reliable method is by proportional amount of BSA or body weight. Because of the differences in weight among children, age is not a reliable method. Because of the differences in height among children, this is not a reliable method. Placement on a growth scale identifies how the child corresponds to other children on a percentile. Although it is determined by a specific measurement, the percentile identified would not be a specific measurement; therefore, this is not a reliable method.

DIF: Cognitive Level: Comprehension REF: p. 76 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Development 5. Which medication route provides the most rapid onset of a medication but also poses the

greatest risk of adverse effects? a. Intradermal b. Subcutaneous (subcut) c. Intramuscular (IM) d. Intravenous (IV) ANS: D

IV medications are delivered directly into the bloodstream and avoid the ―first pass‖ effect of the liver. Intradermal, subcut, and IM administration have a slower absorption rate.

DIF: Cognitive Level: Knowledge REF: p. 77 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety

6. Which is known as the ―fifth vital sign‖? a. Temperature b. Respirations c. Pain d. Pulse ANS: C

Pain is known as the ―fifth vital sign.‖ DIF: Cognitive Level: Knowledge REF: p. 62 OBJ: 6 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Pain 7. Which is true regarding the unit dose drug distribution system? a. The inventory is delivered to each nursing unit on a regular and recurring basis. b. The system delivers one dose of each medication to be administered until the

subsequent delivery of inventory. c. The use of single dose packages of drugs dispensed to fill each dose requirement as it is ordered. d. The amount of inventory needed to dose all patients on the unit for a 24-hour interval.

ANS: C

The unit dose drug distribution system uses single unit packages of drugs dispensed to fill each dose requirement as it is ordered.

DIF: Cognitive Level: Comprehension REF: p. 68 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 2 CON: Clinical Judgment | Safety

8. The nursing assessment identifies that the client is nauseated and cannot take acetaminophen

(Tylenol) orally. Which is true regarding the substitution of this medication to suppository form? a. It is standard practice when the patient is unable to take the ordered medication. b. It is acceptable if the patient agrees to the altered route form. c. It is preferable to having the patient miss a dose of the medication. d. It is contraindicated without an order from the healthcare provider.

ANS: D

One dosage form of medication should never be substituted for another unless the prescriber is consulted; there can be a great variation in the absorption rate of the medication through different routes of administration. The substitution of one form for another is not standard practice and is not acceptable or preferable without the prescriber‘s order.

DIF: Cognitive Level: Comprehension REF: p. 76 | p. 77 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 CON: Clinical Judgment | Safety

9. Which medication order requires nursing judgment and means ―administer if needed‖? a. Morphine 4 mg IV stat b. Morphine 4 mg IV prior to procedure

c. Morphine 4 mg IV four times a day d. Morphine 4 mg IV every 4 hours PRN ANS: D

PRN indicates for the nurse to administer morphine every 4 hours if needed and requires nursing judgment. Stat means the dose of morphine would be given immediately, not as needed. The orders for the dose of morphine to be given prior to the patient‘s scheduled procedure and four times a day do not indicate to give the dose as needed.

DIF: Cognitive Level: Comprehension REF: p. 72 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 6 CON: Clinical Judgment | Safety

10. What is medication reconciliation? a. Comparing the patient‘s current medication orders to all of the medications

actually being taken b. The administration of high alert medications that have been ordered on admission

to an acute care facility c. The completion of an incident report following a variance that resulted in a serious

complication d. A printout of computerized patient data that identifies the times that all of the

ordered medications are to be administered ANS: A

Medication reconciliation is the process of comparing a patient‘s current medication orders to all of the medications that the patient is actually taking. Administering high alert medications and completing an incident report are not the same as medication reconciliation. A printout of computerized patient data that identifies the times that all of the ordered medications are to be administered is a description of the medication administration record (MAR), not a description of medication reconciliation.

DIF: Cognitive Level: Knowledge REF: p. 73 OBJ: 2 | 4 | 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Care Coordination | Health Promotion 11. Which example best demonstrates safe drug administration by the nurse? a. Administering an oral medication with the patient sitting upright b. Asking children to say their name before administering the medication c. Leaving the medications on the bedside stand after verifying patient identification d. Returning the unused portion of a medication to a stock supply bottle ANS: A

Sitting the patient upright for oral medications is safe medication practice. Children should never be asked their names as a means of positive identification. Remaining with a patient until the drug is swallowed is safe practice. Returning an unused portion of medication to the stock supply bottle is not safe medication practice.

DIF: Cognitive Level: Comprehension REF: p. 77 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: N/A CON: Clinical Judgment | Safety

12. Which action will the nurse take when determining that a prescribed medication has not been

administered as ordered on the previous shift? a. Administer the medication immediately. b. Complete an incident report. c. Notify the nurse responsible for the error. d. Record the occurrence in the nurse‘s notes.

ANS: B

An incident report is completed when a medication error occurs. Depending on the medication and frequency of administration, the medication may not be given immediately. It is not the nurse‘s responsibility to notify another nurse of the error. Medication errors are not recorded in the nurse‘s notes.

DIF: Cognitive Level: Application REF: p. 76 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 | 6 CON: Clinical Judgment | Safety

13. Which is the next step, according to the US Food and Drug Administration (FDA) guidelines,

to take when a patient‘s liquid cough medicine has been discontinued with one-half of the bottle remaining? a. To save the remainder for another patient with the same prescription. b. To flush the remainder down the toilet. c. To read the drug label for specific disposal instructions. d. To pour remaining medication into a hazardous waste container.

ANS: C

The nurse must follow specific disposal instructions on the drug label or in the patient information leaflet that accompanies the medication. Prescription medications should not be shared among patients. Prescription drugs should not be flushed down the toilet unless specifically instructed to do so by the manufacturer. The first action to be taken is to follow disposal instructions on the label. If the drug label indicates it should be emptied into a hazardous waste container, measures should be taken to prevent leaking and/or accidental ingestion.

DIF: Cognitive Level: Analysis REF: p. 71 OBJ: 6 | 7 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety MULTIPLE RESPONSE 1. Who defines the standards of care for the practice of nursing? (Select all that apply.) a. State boards of nursing b. Hospital policy and procedures c. Federal laws regulating healthcare facilities d. The Joint Commission e. Professional nursing associations ANS: A, C, D, E

Standards of care are defined by state boards of nursing, federal laws regulating healthcare facilities, The Joint Commission, and professional nursing associations such as the American Nurses Association. Individual hospital policies and procedures incorporate federal and state guidelines into their respective policies and procedures and are often more stringent than state and federal regulations.

DIF: Cognitive Level: Knowledge REF: p. 60 | p. 61 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Health Care Law | Health Care Organizations 2. What must the nurse have before administering any medication? (Select all that apply.) a. A current license to practice b. A medication order signed by a practitioner licensed with prescription privileges c. Knowledge of the medication d. Consultation with a pharmacist e. Knowledge of the client‘s diagnosis ANS: A, B, C, E

Physicians must be licensed to prescribe medications; nurses must be licensed to administer medications. Safe medication administration includes knowledge of the medication, pathophysiology of patient diagnoses, and pharmacodynamics of the ordered medication on the pathophysiology. It is not necessary for the nurse to consult with a pharmacist each time medication is to be administered to a patient.

DIF: Cognitive Level: Comprehension REF: p. 60 | p. 61 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Health Care Law | Clinical Judgment 3. Which advantage(s) does the unit dose drug distribution system include? (Select all that

apply.) a. There is decreased participation by the pharmacy. b. The pharmacist is able to analyze prescribed medications for each client for drug interactions and contraindications. c. There is less waste of medications. d. The time spent by nursing personnel preparing these medications is increased. e. Credit is given to the patient for unused medications.

ANS: B, C, E

Because the pharmacist has a profile of all medications for each patient, he or she is able to analyze prescribed medications for each patient for drug interactions and contraindications.

This is an advantage of the unit dose drug distribution system. Less waste of medications is an advantage of the unit dose drug distribution system. Because each dose is individually packaged, credit can be given to the patient for unused medications. There is increased pharmacist involvement and better use of his or her extensive drug knowledge, and nursing personnel time is decreased with this method.

DIF: Cognitive Level: Knowledge REF: p. 67 OBJ: 2 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Care Coordination | Safety | Health Care Policy

4. Which statement(s) is/are true regarding the types of medication orders? (Select all that

apply.) a. Stat orders are the same as single dose orders. b. Standing orders indicate the number of specified doses of a medication to be given. c. Renewal orders facilitate physician review before continuance of high-risk medications. d. PRN medications will designate a mandatory number of times the medication is to be administered. e. Verbal orders should be used as much as possible.

ANS: B, C

Standing orders state the frequency of medication dosages to be administered or indicate the time frame of administration. Renewal orders require the physician to review medications that have ―expired orders,‖ as determined by facility policy. Renewal policies facilitate physician verification of the necessity to continue a medication beyond a ―usual‖ time frame and help ensure patient safety. Single dose and stat orders are not the same. PRN medications are not ordered a mandatory number of times, although a maximum number might be specified.

Verbal orders should be avoided whenever possible.

DIF: Cognitive Level: Comprehension REF: p. 72 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Safety | Health Care Policy 5. Which statement(s) is/are true regarding computerized prescriber order entry (CPOE)? (Select

all that apply.) a. Integrates the ordering system with the pharmacy, laboratory, and nurses‘ stations. b. Provides instant access to online information to facilitate patient care needs. c. Facilitates review of ordered medications for potential drug interactions. d. Facilitates review of drugs for appropriateness of dosages. e. Alleviates the need to perform mathematical computations.

ANS: A, B, C, D

CPOE systems integrate patient information, provide instant access, facilitate review of ordered medications for potential drug interactions, and facilitate review of drugs for appropriateness of dosages. Alleviation of the need to perform mathematical computations is not a component of the CPOE system.

DIF: Cognitive Level: Comprehension REF: p. 72 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity | NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Care Coordination | Technology and Informatics 6. Which lab test(s) would be used to assess liver and/or renal function before administering

medications? (Select all that apply.) a. CBC b. LDH c. ALT d. Crs e. BUN f. aPTT

ANS: B, C, D, E

Liver function tests include LDH (lactic dehydrogenase) and ALT (alanine aminotransferase).

Renal function tests include Crs (serum creatinine) and BUN (blood urea nitrogen). Although a CBC (complete blood count) and an aPTT are useful in assessing the patient before administration of medication, they are not renal or hepatic function tests.

DIF: Cognitive Level: Knowledge REF: p. 76 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Health Promotion 7. Which characteristic(s) of Lanoxin are important to know prior to administration? (Select all

that apply.) a. Chemical composition b. Adverse effects c. Expected actions d. Contraindications for use e. Usual dosing ANS: B, C, D, E

The nurse must understand the individual patient‘s diagnosis and symptoms that correlate with the rationale for drug use. The nurse should also know why a medication is ordered, expected actions, usual dosing, proper dilution, route and rate of administration, adverse effects, and contraindications for the use of a particular drug. It is not required that the nurse know the chemical composition of the medication prior to administration.

DIF: Cognitive Level: Comprehension REF: p. 74 OBJ: 5 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety 8. The nurse transcribes an order to administer Valium 10 mg IV stat. Which directive(s)

indicate how this order is to be correctly provided? (Select all that apply.) a. As needed b. Immediately c. One time only d. In divided doses e. Intravenously ANS: B, C, E

The stat order is generally used on an emergency basis. It means that the drug is to be administered as soon as possible, but only once. IV indicates the route is intravenous. A PRN order means ―administer if needed.‖ The order would specify ―divided doses‖ and amount per dose if indicated.

DIF: Cognitive Level: Analysis REF: p. 73 | p. 74 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety

Chapter 07: Percutaneous Administration Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition

MULTIPLE CHOICE 1. Which type of dressing would the nurse use when a patient has an infected wound with large

amounts of drainage? a. Telfa b. OpSite c. DuoDerm d. AlgiDERM ANS: D

AlgiDERM is manufactured from seaweed and is recommended for infected wounds because it is an exudate absorber. Telfa and OpSite do not absorb exudates. DuoDerm is for light to moderate wound drainage. According to the manufacturer, it does absorb exudates, but it is best for wounds with moderate drainage.

DIF: Cognitive Level: Comprehension REF: p. 84 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Tissue Integrity | Infection

OBJ: 1

2. Which site would the nurse apply nitroglycerin ointment on a male patient? a. The same site that was previously used b. A hairy area of the chest c. The upper arm d. The back of the knee ANS: C

Any area without hair may be used. Most people prefer the chest, flank, or upper arm areas.

Sites should be rotated. The back of the knee is not suitable for applying medication because of the joint motion and difficulty of keeping a dressing in place.

DIF: Cognitive Level: Comprehension REF: p. 87 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 3 CON: Clinical Judgment | Safety

3. Which area will the nurse administer a medication that was ordered to be given sublingually? a. Between the molar teeth and cheek b. Below the skin surface c. Under the tongue d. Into the conjunctival sac ANS: C

The sublingual area is underneath the tongue. Between the molar teeth and cheek is the buccal area. Medication administered below the skin surface is intradermal administration. The conjunctival sac is between the eyelids and eyeball.

DIF: Cognitive Level: Knowledge REF: p. 90 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 5 CON: Clinical Judgment | Safety

4. Why are sublingual and buccal medications rapidly absorbed? a. Their action is localized to the mouth.

b. They are metabolized in the liver. c. Blood flow is diminished in these sites. d. These drugs pass directly into systemic circulation.

ANS: D

Sublingual medications are rapidly absorbed into systemic circulation because of the increased blood flow to these areas and avoid the ―first pass‖ effect of the liver where extensive metabolism usually takes place. These routes do not contain drug effects to the oral area and they bypass the liver. These sites are highly vascular.

DIF: Cognitive Level: Comprehension REF: p. 90 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 5. Which medications must be sterile? a. Topical b. Vaginal c. Ophthalmic d. Nasal ANS: C

Ophthalmic (eye) medications must be sterile. Topical, vaginal, and nasal applications do not need to be sterile.

DIF: Cognitive Level: Knowledge REF: p. 91 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: N/A CON: Clinical Judgment | Safety

6. Which action will the nurse perform when doing a wet to dry dressing every 4 hours on a

patient with a deep wound? a. Pack the wound tightly with gauze. b. Saturate the dressing with as much liquid as possible. c. Use Montgomery tapes or a binder to secure the dressing. d. Apply the new moist dressing over the existing one.

ANS: C

The use of Montgomery tapes or a binder reduces the irritation of nearby skin tissue. The dressing should be packed into the wound loosely. The dressings should be wrung out to prevent dripping. The previous dressing should always be completely removed.

DIF: Cognitive Level: Application REF: p. 85 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 CON: Clinical Judgment | Safety

7. Which nursing intervention is correct when applying nitroglycerin topically? a. Secure the paper on two sides with tape. b. Shave the area prior to application of the paper. c. Wear gloves while placing the new paper. d. Remind the patient to discontinue use of the medication if chest pain is relieved.

ANS: C

Wearing gloves prevents accidental exposure to the medication. The area where the paper is placed should be covered with plastic wrap and taped into place to prevent medication from seeping out. Shaving may cause skin irritation. The dosage and frequency of application should be gradually reduced over 4 to 6 weeks, and the patient should contact the healthcare provider if adjustment is desired.

DIF: Cognitive Level: Comprehension REF: p. 88 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 3 CON: Clinical Judgment | Safety

8. Which site is correct to administer ophthalmic medication? a. At the inner canthus of the eye b. In the lower conjunctival sac c. Directly onto the eyeball d. To the outer corner of the eyelid ANS: B

The lower conjunctival sac is exposed by applying gentle traction to the lower lid at the bony rim of the orbit. The inner canthus allows medication to flow out of the eye. Applying directly to the eyeball risks injury to the globe. The outer corner of the eyelid allows medication to flow out of the eye.

DIF: Cognitive Level: Knowledge REF: p. 91 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 5 CON: Clinical Judgment | Safety

9. Which effect would be important for the nurse to address when teaching a patient about the

overuse of nose drops? a. Rebound b. Ceiling c. Idiosyncratic d. Measured ANS: A

Rebound effect may occur with overuse of some medications. Ceiling effect is the greatest attainable response. An idiosyncratic effect may occur even with prudent use of nose drops.

Measured effect is the patient‘s response to the medication.

DIF: Cognitive Level: Application REF: p. 95 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education | Health Promotion 10. Which nursing assessment accurately describes the results of an intradermal skin test? a. Itching and weeping b. Erythema and induration c. Swelling and coolness d. Pallor and drainage ANS: B

The result should be measured by diameter of erythema in millimeters, and the induration should be palpated and measured in millimeters. Itching is not relevant to the results; weeping should be reported to the healthcare provider but is not pertinent to the evaluation of the skin test. Swelling, coolness, pallor, and drainage are not relevant to evaluation; reporting this to the healthcare provider is appropriate but not pertinent to the evaluation of the skin test.

DIF: Cognitive Level: Comprehension REF: p. 86 | p. 87 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment 11. Which advantage applies to nitroglycerin ointment? a. It does not give the patient a bad taste in the mouth. b. The amount of ointment does not matter in obtaining a therapeutic response. c. It does not cause headaches as an adverse effect. d. It provides relief of anginal pain for several hours longer than sublingual

medication.

ANS: D

Nitroglycerin ointment provides relief of anginal pain for several hours longer than sublingual preparations. Nitroglycerin pills do not have a bad taste. Dosage is critical to the success of use. All nitroglycerin preparations may cause headaches because of vasodilation.

DIF: Cognitive Level: Comprehension REF: p. 87 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Pain | Health Promotion

OBJ: 3

12. Which action will the nurse perform when administering a transdermal patch to a patient with

metastatic cancer being admitted to the hospital for pain control? a. After removal, dispose of the old patch in a receptacle in the patient‘s room. b. Change the fentanyl patch every day, either in the morning or at bedtime. c. Hold the short-acting oral pain medication when a fentanyl patch is initiated. d. Label the patch with date, time, dosage, and initials after patch placement.

ANS: D

Labeling is appropriate when transdermal disks are placed. Patches are to be disposed of in a receptacle on the medication cart, not in the patient‘s room. Fentanyl patches are changed every 72 hours. Fentanyl patches take up to 12 hours to be effective; therefore, short-acting pain medication is continued.

DIF: Cognitive Level: Application REF: p. 89 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Pain | Safety

OBJ: 4

13. Which rationale supports the nurse applying gentle pressure to the inner corner of the eyelid

after instilling eyedrops? a. Decreases the risk of infection. b. Maintains intraocular pressure. c. Prevents systemic effects. d. Provides comfort to the patient.

ANS: C

Application of pressure to the inner corner of the eye prevents the medication from entering the canal, where it would be absorbed in the vascular mucosa of the nose and produce systemic effects. Application of pressure to the inner corner of the eye does not decrease infection, maintain intraocular pressure, or promote patient comfort.

DIF: Cognitive Level: Comprehension REF: p. 91 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 5 CON: Clinical Judgment | Safety

14. Which statement by the patient indicates the need for further teaching about the use of a

corticosteroid inhaler? a. ―I will shake the inhaler before I use it.‖ b. ―I need to rinse my mouth after I use the inhaler.‖ c. ―I will use this when I‘m lying in bed in the morning.‖ d. ―After I inhale, I will hold my breath and then breathe out slowly.‖ ANS: C

The sitting position allows for maximum lung expansion. Shaking the inhaler helps to disperse the medication. The mouth needs to be rinsed after the inhalation of a corticosteroid.

Holding the breath then exhaling slowly allows the drug to settle into pulmonary tissue.

DIF: Cognitive Level: Application REF: p. 96 OBJ: 7 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education | Health Promotion 15. Which appropriate nursing action is implemented when administering a vaginal suppository? a. Ask the patient to urinate prior to insertion. b. Assist the patient to a side-lying position. c. Keep suppository refrigerated prior to insertion. d. Insert the suppository 1 inch into the vagina.

ANS: A

An empty bladder facilitates insertion. A side-lying position would not facilitate insertion of a vaginal suppository. The suppository needs to be warmed to room temperature before it is administered. The suppository is inserted more than 1 inch.

DIF: Cognitive Level: Application REF: p. 98 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 8 CON: Clinical Judgment | Safety

16. Which is an accurate nursing action when treating a patient‘s rash with a lotion? a. Avoid shaking the container prior to application. b. Cleanse area with alcohol prior to treatment. c. Cover the area with gauze because of the oil base. d. Pat on the area with a gloved hand.

ANS: D

To prevent increased circulation and itching, lotions should be gently but firmly patted on the skin, rather than rubbed in. Shake all lotions thoroughly immediately before application.

Lotions are aqueous and are easily cleansed with water. Lotions are not oil based.

DIF: Cognitive Level: Application REF: p. 84 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 CON: Clinical Judgment | Safety

17. A 2-year-old child is hospitalized with the diagnosis of tonsillitis and bilateral otitis media.

The nurse is preparing to administer eardrops. When instilling the eardrops, the nurse will pull the earlobe a. upward and back. b. sideways and down. c. downward and back. d. sideways and up.

ANS: C

For children under 3 years, pull the earlobe downward and back with eardrop instillation to straighten the external auditory canal. The earlobe is pulled up and back for adults and children ages 3 and over.

DIF: Cognitive Level: Application REF: p. 92 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Development

OBJ: 6

18. The nurse is preparing an otic solution. When instructing the patient in regard to area of

administration, the nurse will explain that the solution will be placed a. into the eye. b. under the tongue. c. topically. d. into the ear.

ANS: D

Medications for use in the ear are labeled otic. Ophthalmic solutions are administered into the eye. Sublingual medications are administered under the tongue. Topical medications are applied to the skin.

DIF: Cognitive Level: Comprehension REF: p. 92 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education

OBJ: 6

MULTIPLE RESPONSE 1. Which order(s) would be examples of percutaneous medication administration? (Select all

that apply.) a. Timolol 0.5% 1 drop to each eye daily b. Albuterol nebulizer 2.5 mg qid c. Heparin 5000 units IV d. Lasix 20 mg PO every AM e. Silvadene 1% topically to affected area ANS: A, B, E

Percutaneous administration refers to applying medications to the skin or mucous membranes for absorption, such as eyedrops.

DIF: Cognitive Level: Comprehension REF: p. 83 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 | 7 CON: Clinical Judgment | Safety

2. Which action(s) will the nurse perform when preparing to administer a topical medication?

(Select all that apply.) a. Wash hands before and after administration. b. Maintain a dry environment to encourage wound healing. c. Wear gloves during the application process. d. Use sterile dressings for all wounds.

ANS: A, C

Handwashing is an essential part of medication administration. Gloves are worn with topical medication to prevent absorption into the practitioner‘s own skin. Dryness does not encourage wound healing. Sterile dressings do not work well for all wounds.

DIF: Cognitive Level: Application REF: p. 83 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Infection | Health Promotion

OBJ: 1

3. Which dressings would be appropriate to use for treating wounds with exudates? (Select all

that apply.) a. AlgiDERM b. Telfa c. Kaltostat d. Sorbsan e. OpSite ANS: A, C, D

AlgiDERM, Kaltostat, and Sorbsan are exudate absorbers for use in treating infected wounds.

Telfa and OpSite are not appropriate to use on wounds with exudates.

DIF: Cognitive Level: Knowledge REF: p. 84 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Infection | Health Promotion

OBJ: 1

Chapter 08: Enteral Administration Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which position would the nurse place a patient in before the administration of an enteral

feeding? a. Supine b. Semi-Fowler‘s c. Left lateral

d. Prone ANS: B

To facilitate gastric emptying, the patient should be placed in a semi-Fowler‘s position (30-degree head-of-bed [HOB] elevation) for 30 minutes before the start of the feeding.

Aspiration is a risk during enteral feedings in the supine position and in the left lateral position. The prone position would prevent gastric emptying and increase the risk of aspiration.

DIF: Cognitive Level: Application REF: p. 111 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 4 CON: Clinical Judgment | Safety

2. Which type of lubricant would the nurse use to administer a rectal suppository? a. Petroleum jelly b. Mineral oil c. Water soluble d. Anesthetic ANS: C

Water-soluble lubricants should be used with rectal suppository administration. When not available, water can be used to moisten mucosal surfaces. Petroleum-based and oil-based lubricants can harbor bacteria and promote infection. Unless the patient has pain in the rectal area (in which case another route of administration should be considered), anesthetic should not be required.

DIF: Cognitive Level: Knowledge REF: p. 114 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 5 CON: Clinical Judgment | Safety

3. Which is a characteristic of medication administration via the rectal route? a. Irritation of the mouth b. Nausea and vomiting c. Bypassing of the digestive enzymes d. Use of the first pass metabolism ANS: C

Rectal administration bypasses the digestive enzymes because the medication is absorbed directly into the bloodstream. Rectal administration bypasses the oral cavity and does not affect the gag reflex or upset the stomach. Rectal administration bypasses first pass metabolism.

DIF: Cognitive Level: Knowledge REF: p. 103 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 5 CON: Clinical Judgment | Nutrition

4. Which medications are provided in dried, powdered form compressed into small disks? a. Pills b. Capsules c. Tablets d. Lozenges

ANS: C

Tablets are dried, powdered drugs that have been compressed into small disks. Pills are an obsolete dose form that is no longer manufactured as a result of the development of capsules and compressed tablets. Capsules are small cylindrical gelatin containers that hold dry powder or liquid medicine. Lozenges are small aromatic medicated candies, such as cough drops.

DIF: Cognitive Level: Knowledge REF: p. 104 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 CON: Clinical Judgment | Safety

5. Which action by the nurse is appropriate when administering enteric coated tablets? a. Administer with an antacid. b. Crush the tablet and mix with applesauce. c. Encourage the patient to drink a full glass of water. d. Instruct the patient to place the medication between the cheek and teeth.

ANS: C

Drinking a full glass of water ensures the medication reaches the stomach and is diluted to decrease the potential for irritation. Administering with an antacid would alter the dissolution of the enteric coated tablet because it has a coating that resists dissolution in the acidic pH of the stomach but is dissolved in the intestines. Enteric coated tablets must not be crushed and must be swallowed.

DIF: Cognitive Level: Application REF: p. 104 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 CON: Clinical Judgment | Safety

6. Which route of administration would be ordered by the healthcare provider if a patient is

vomiting? a. Gastrostomy tube b. Intradermal c. Ophthalmic d. Rectal ANS: D

The rectal route is a good alternative when nausea or vomiting is present. Gastrostomy is used for patients who cannot swallow or have had oral surgery; drugs administered by this route would be placed in the gastrointestinal tract and are inappropriate for the patient with vomiting. Intradermal routes are used for allergy testing. Ophthalmic medications are for use in the eye.

DIF: Cognitive Level: Comprehension REF: p. 103 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 | 5 CON: Clinical Judgment | Safety

7. Which action will the nurse take first after entering the patient‘s room to administer oral

medications? a. Assist the patient to sit upright. b. Check the patient‘s identification. c. Inform the patient about the medications. d. Offer the patient something to drink.

ANS: B

Checking the patient‘s identification is the first nursing action once at the bedside. Assisting the patient to sit upright is appropriate when administering oral medications, but this is not the first thing the nurse would do. Providing information about medications is appropriate, but it is not the first thing the nurse would do. Offering the patient something to drink to facilitate swallowing of medications is appropriate, but it is not the first thing the nurse would do.

DIF: Cognitive Level: Application REF: p. 107 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 CON: Clinical Judgment | Safety

8. Which instruction will be encouraged when administering a medication in tablet form to a

patient? a. Drink a large amount of water prior to administration so that swallowing is easier. b. Place the medication on the front of the tongue. c. Keep the head forward while swallowing. d. Minimize the amount of fluid taken following medication administration.

ANS: C

The patient should be encouraged to keep the head forward while swallowing. The patient should be allowed to drink a small amount of water to moisten the mouth so that swallowing the medication is easier. The patient should be instructed to place the medication well back on the tongue. Drinking a full glass of fluid should be encouraged to ensure that the medication reaches the stomach and is diluted to decrease the potential for irritation.

DIF: Cognitive Level: Application REF: p. 108 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 CON: Clinical Judgment | Safety

9. Which type of fluid is represented when aspirated stomach contents are assessed to be green

with sediment? a. Pleural b. Gastric c. Intestinal d. Tracheobronchial ANS: B

Gastric fluid appears green with sediment or off white. Pleural fluid appears clear to straw colored. Intestinal fluid appears yellow (bile colored). Tracheobronchial fluid appears off white or tan.

DIF: Cognitive Level: Comprehension REF: p. 111 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment MULTIPLE RESPONSE 1. Which principle(s) are included with oral drug administration? (Select all that apply.) a. Dependable rate of absorption b. Most economical c. Insulin able to be administered via this route

d. Drugs delivered directly by the oral, rectal, or nasogastric (NG) methods e. Dosage forms are convenient and readily available ANS: B, E

Oral administration is the most economical, convenient, and readily available. Absorption from oral medications can vary depending on many factors. Insulin cannot be administered via the oral route. In oral drug administration, drugs are only delivered via the oral route.

DIF: Cognitive Level: Comprehension REF: p. 103 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Health Promotion | Patient Education 2. The nurse is administering an oral medication to a 90-year-old patient who has difficulty

swallowing pills. One of the medications to be administered is a spansule type capsule. Which nursing consideration(s) should be applied in this case? (Select all that apply.) a. Wash hands before preparing medications and before administration. b. Crush medications and administer with a soft food, such as applesauce. c. Check the patient‘s ID band with the MAR to ensure patient rights are followed. d. Have an 8-oz glass of water available. e. Check with the pharmacist to see if the spansule medication comes in a liquid form.

ANS: A, C, D, E

Hands should be washed before and after medication preparation. Always check the patient‘s identification before administering medication. Have water available to the patient when administering this medication. Giving the medication in liquid form, if available, would be much more comfortable for the patient. Spansule medications are time released and should not be crushed.

DIF: Cognitive Level: Application REF: p. 108 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Development

OBJ: 1

3. Which receptacle(s) is/are commonly used in the hospital with pediatric oral medications?

(Select all that apply.) a. Oral syringe b. Baby bottle full of formula c. Infant feeding nipple d. Teaspoon e. Medicine dropper ANS: A, C, E

An oral syringe or plastic medicine cup would be most accurate. An infant feeding nipple is commonly used for pediatric patients. A medicine dropper may be used to administer medications to pediatric patients. A full bottle of formula is too large a volume in which to administer medication. A teaspoon does not minimize the risk of spilling when administering medication to a pediatric patient.

DIF: Cognitive Level: Comprehension REF: p. 106 NAT: NCLEX Client Needs Category: Physiological Integrity

OBJ: 3

TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Development 4. Which data will the nurse document when administering a PRN oral pain medication to a

patient? (Select all that apply.) a. Date, time, drug name, dosage, and route of administration b. Essential patient education about the drug completed c. Administration receptacle used d. Signs and symptoms of adverse drug effects e. Evaluation of therapeutic effectiveness ANS: A, B, D, E

Date, time, drug name, dosage, and route of administration are included in the seven rights of medication administration. The patient should be educated about the drug being administered.

The nurse should observe for adverse drug effects. Evaluating the drug‘s therapeutic effectiveness is important. Unless the receptacle used is unusual, it does not need to be noted.

DIF: Cognitive Level: Comprehension REF: p. 110 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Pain | Health Promotion | Patient Education 5. Which principle(s) is/are included with gastrointestinal medication administration? (Select all

that apply.) a. The tube must be assessed for correct placement. b. All medications can be combined into one syringe. c. Tablets and capsules should be dissolved in water. d. The suction source should be immediately reconnected. e. Flush the tube with 30 mL of water after drug administration.

ANS: A, C, E

It is essential to verify correct placement of an NG tube. Solid medications must be crushed and dissolved in water before administration (with the exception of enteric coated tablets).

Capsules should be opened and granules or powder sprinkled into 30 mL of water to dissolve (with the exception of timed released capsules). Flushing the tube serves to clear the tube and ensure that the drug has been transported to the intestine. Incompatible medications should not be combined. Suction will evacuate the medication from the patient.

DIF: Cognitive Level: Comprehension REF: p. 110 | p. 111 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety 6. Which nursing action(s) would be appropriate when administering a disposable enema?

(Select all that apply.) a. Position the patient on the left side. b. Allow the solution to flow in by gravity. c. Instruct the patient to hold the solution 30 minutes before defecating. d. Maintain the six rights of medication administration. e. Lubricate the rectal tube.

ANS: A, C, D, E

To facilitate flow into the large intestine, patients should be positioned on the left side. The solution should be held for 30 minutes before defecating. Enemas are medications, so the seven rights of medication administration should be followed. Lubrication of the rectal tube will facilitate insertion into the rectum. Gravity will not facilitate the administration of a small volume of enema solution administered from a bottle.

DIF: Cognitive Level: Knowledge REF: p. 115 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education

OBJ: 5

7. Which type of medication is appropriate to give through a gastrointestinal tube? (Select all

that apply.) a. Liquid medication b. Tablets crushed and diluted in 30 mL of water c. Enteric coated tablets crushed and diluted in 30 mL of water d. Capsules emptied into 30 mL of water e. Timed release capsules emptied into 30 mL of water f. Suppositories ANS: A, B, D

Liquid forms of medications are preferable. Tablets may be crushed and diluted in water.

Capsules may be opened and the contents added to approximately 1 oz of water. Enteric coated medications and timed release capsules should never be broken for administration.

Suppositories are not given via NG route.

DIF: Cognitive Level: Application REF: p. 110 | p. 111 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety 8. Which method(s) of administration can be used for an adult patient receiving 10 mL of cough

syrup at 0800? (Select all that apply.) a. Soufflé cup b. Medicine cup c. Oral syringe d. Teaspoon e. Nipple ANS: B, C

The medicine cup is a plastic container with three scales to measure liquid medications. An oral syringe comparable to the volume to be measured can be used for smaller volumes such as 10 mL. A soufflé cup is a small paper or plastic cup used to transport solid medication forms such as a capsule or tablet to the patient to prevent contamination by handling. A teaspoon is equal to 5 mL. An infant feeding nipple with additional holes may be used for administering oral medications to infants.

DIF: Cognitive Level: Comprehension REF: p. 106 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 3 CON: Clinical Judgment

Chapter 09: Parenteral Administration: Safe Preparation of Parenteral Medications Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition

MULTIPLE CHOICE 1. Which part of the syringe contains the calibrations for drug volume measurement? a. Plunger b. Tip c. Luer Lok d. Barrel ANS: D

The barrel contains the calibrations necessary for measurement. The plunger, the tip, and the Luer Lok do not have the calibrations indicated on them.

DIF: Cognitive Level: Knowledge REF: p. 120 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety 2. Which needle will the nurse use to administer an intramuscular (IM) immunization on an

18-month-old child? a. 18-gauge, 1-inch needle b. 20-gauge, -inch needle c. 27-gauge, -inch needle d. 25-gauge, -inch needle ANS: C

The most appropriate needle gauge for pediatric IM injections is a 25- or 27-gauge, -inch needle. An 18-gauge, 1-inch needle is too short and too large in diameter for pediatric injections. A 20-gauge, -inch needle is too short and too large in diameter for pediatric injections. A 25-gauge, -inch needle is too short for pediatric IM injections.

DIF: Cognitive Level: Application REF: p. 124 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Development

OBJ: 3

3. Which syringe will the nurse use to administer insulin subcutaneously to a patient? a. A syringe calibrated in minims. b. A syringe calibrated in units. c. A syringe calibrated in tenths of mL. d. A syringe calibrated in mL. ANS: B

A syringe calibrated in units is used for insulin. A tuberculin syringe is not properly calibrated for use with insulin. A syringe calibrated in mL or in tenths of mL would not be an accurate way to measure insulin doses.

DIF: Cognitive Level: Comprehension REF: p. 121 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 CON: Clinical Judgment | Safety

4. Which action by the nurse is most accurate when drawing up medication from an ampule? a. Consider the rim of the ampule as sterile. b. Use a filter needle to withdraw the medication. c. Wrap a paper towel around the neck of the ampule before breaking it. d. Inject 0.5 mL of air into the ampule before withdrawing the medication.

ANS: B

Filtered needles are used to withdraw the medication and then changed before administration of the injection. The rim of the ampule is considered to be contaminated because of the possible presence of broken glass. Paper towels do not protect the nurse from broken glass.

The ampule is not airtight, so no air needs to be injected into it before removing the medication.

DIF: Cognitive Level: Application REF: p. 130 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 5 CON: Clinical Judgment | Safety

5. Which action by the nurse is accurate when withdrawing medication into a syringe from a

vial? a. Inject an amount of air equal to the medication into the vial. b. Break the thin neck of the vial container. c. Remove the rubber stopper on the top of the vial. d. Discard the initial 0.5 mL of medication to ensure sterility.

ANS: A

An equal amount of air is first injected into the vial to help displace the needed medication upon withdrawal. Vials are not meant to be broken at the neck. Removal of the rubber stopper on a vial is unsafe and not recommended. Medication should not be discarded because it is sterile as long as the vial is airtight and has not been contaminated.

DIF: Cognitive Level: Application REF: p. 130 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 5 CON: Clinical Judgment | Safety

6. Which action by the nurse is most important in order to mix medications in one syringe? a. Assess for the presence of adequate muscle mass. b. Ensure that the combined medication amount is less than 2 mL. c. Determine the compatibility of the medications. d. Use a needle that is 25 gauge.

ANS: C

Compatibility is determined to prevent a reaction between the mixed medications. This is important once the medication will be administered, but first it needs to be determined that the medications can be mixed. IM injections in the adult can exceed 2 mL. A 25-gauge needle is not appropriate for an IM injection.

DIF: Cognitive Level: Comprehension REF: p. 131 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 6 CON: Clinical Judgment | Safety

7. The nurse is preparing to administer insulin. What does U-100 indicate when preparing to

administer insulin?

a. b. c. d.

100 mL/unit 10 units/mL 100 units/mL 10 units/100 mL

ANS: C

U 100 means 100 units/mL. DIF: Cognitive Level: Comprehension REF: p. 121 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 8. Which statement by the patient learning about proper disposal of used syringes and needles

indicates a need for further teaching? a. ―Even needles with sleeves should be disposed of appropriately.‖ b. ―It is unusual that anyone could get a needle injury or disease from used needles.‖ c. ―It is important for me to use the designated container to dispose of my syringes and needles.‖ d. ―I am going to purchase the ‗Sharps by Mail Disposal System‘ once I am home.‖ ANS: B

The patient needs more education because injury from needlesticks and transfer of pathogens is a health concern. It is accurate that even needles with sleeves should be disposed of appropriately and that a designated container to dispose of syringes and needles should be used. The patient should be encouraged to purchase the ―Sharps by Mail Disposal System.‖ DIF: Cognitive Level: Application REF: p. 126 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety | Patient Education 9. Which nursing action is accurate when administering parenteral medication? a. Adjust the route of the medication, if needed. b. Document the response to PRN medications at the end of the shift. c. Request the pharmacist to provide education about the medication to the patient. d. Use clinical judgment when rescheduling missed doses of a medication.

ANS: D

The nurse must exercise clinical judgment about the scheduling of new drug orders, missed dosages, modified drug orders or substitution of therapeutically equivalent medicines by the pharmacy, or changes in the patient‘s condition that require consultation with the physician, healthcare provider, or pharmacist. Adjusting the route is not within the role of the nurse.

Documenting the response to PRN medications at the end of the shift is not an acceptable time frame. Educating the patient about the medication is within the nurse‘s role.

DIF: Cognitive Level: Comprehension REF: p. 119 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety 10. Which advantage applies to administering a drug parenterally? a. The duration of action is longer. b. Medications given by this route are inexpensive. c. The onset of action is more rapid.

d. The dose is usually larger than an oral dose.

ANS: C

The onset of drug action is generally more rapid but of shorter duration. Duration of action is not affected by administering a drug parenterally. Parenteral administration can be expensive.

The dose of parenteral medications is typically smaller than an oral dose.

DIF: Cognitive Level: Comprehension REF: p. 119 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety 11. Which information provided by the nurse is most important to include when teaching a patient

about the use of an EpiPen? a. ―Hold the syringe at a 45-degree angle against the skin.‖ b. ―Monitor the expiration date of this medication.‖ c. ―After using the EpiPen, lie down for 1 hour.‖ d. ―Place the syringe in a cartridge prior to using.‖ ANS: B

It is important to monitor the expiration date of this medication on a regular basis. The syringe is held perpendicular to the skin. The patient should go to the emergency department after use of an EpiPen. Placing the syringe into a cartridge is not accurate for use of an EpiPen. DIF: Cognitive Level: Application REF: p. 122 OBJ: 4 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education 12. Which type of parenteral medication container is made of glass, is scored, and needs to be

broken open before withdrawing the medication? a. Ampule b. Carpuject c. Mix-O-Vial d. Vial ANS: A

Ampules are glass containers that need to be broken open before withdrawing medication.

Carpujects are prefilled syringes. Mix-O-Vial containers have two compartments for mixing medications and are not scored. Vials are glass or plastic containers that are not broken open.

DIF: Cognitive Level: Knowledge REF: p. 126 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 5 CON: Clinical Judgment | Safety

13. The operating room (OR) nurse is preparing medications for use in a sterile field during a

surgical procedure. While preparing these medications, the nurse will a. save unused portions of medication for use in another procedure. b. differentiate between sterile and nonsterile medications to be used in the OR. c. ensure the scrub (sterile) nurse retrieves the medication from storage. d. read the label aloud for verification against the order from the surgeon.

ANS: D

It is best to read the label aloud to ensure that both individuals are verifying the contents against the verbal order from the surgeon. Unused portions of medication should not be saved for use in another procedure. All medication during an operative procedure must remain sterile. The circulating (nonsterile) nurse retrieves the medication from storage.

DIF: Cognitive Level: Application REF: p. 133 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Care Coordination | Communication 14. The mother of a 6-year-old child informs the school nurse that the child is allergic to insect

stings and requires an EpiPen. Which action must be taken if the child is stung by an insect while in school? a. Hold the EpiPen perpendicularly against the thigh and activate. b. Provide additional care in the nurse‘s office prior to sending the child back to class. c. Call the physician prior to administration. d. Provide a second dose within 2 minutes following initial dose.

ANS: A

When held perpendicularly against the thigh and activated, the needle of the EpiPen penetrates the skin and a single dose of epinephrine is injected into the muscle. Once the epinephrine is administered, the person should go to a hospital emergency department because additional treatment may be necessary. The physician does not have to be notified prior to administration. A second dose should not be provided at this time.

DIF: Cognitive Level: Application REF: p. 122 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Development

OBJ: 4

MULTIPLE RESPONSE 1. Which principle(s) is/are correct for mixing insulin? (Select all that apply.) a. Insulin orders and calculations must be checked with another nurse. b. Air is injected into the vial of the shorter-acting insulin first. c. The longer-acting insulin is drawn up first. d. The nurse must verify the compatibility of the insulin types. e. Withdraw the shorter-acting insulin first.

ANS: A, D, E

Two nurses should verify orders and prepared insulin amounts to prevent inaccuracy in administration. When two medications are mixed in the same syringe, compatibility must be determined. The shorter-acting insulin is withdrawn first and air is injected into the longer-acting insulin first.

DIF: Cognitive Level: Application REF: p. 131 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 6 CON: Clinical Judgment | Safety

2. Which risk factor(s) should be considered when administering medications by injection?

(Select all that apply.) a. Trauma at the site of the needle puncture b. Possibility of infection c. Irretrievability of the medication once administered d. Delayed absorption e. Delayed onset of action f. Chance of allergic reaction ANS: A, B, C, F

Injecting medications involves risk for trauma, infection, and allergic reaction and increases the difficulty of treating adverse reactions or errors because of the inability to retrieve the medication. Delayed absorption and onset of action are not risks of injecting medications.

DIF: Cognitive Level: Comprehension REF: p. 119 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Health Promotion

OBJ: 1

3. Which intervention(s) should be performed when preparing parenteral medications? (Select all

that apply.) a. Check the expiration date. b. Use sterile technique throughout the entire procedure. c. Check the drug dose form ordered against the source available. d. Prepare the drug in a clean well-lighted area. e. Check calculations.

ANS: A, C, D, E

The standard procedure for preparing all parenteral medications includes checking the expiration date on the medication container, checking the drug dose form ordered against the source available, preparing the drug in a clean well-lighted area, and checking calculations for accuracy. Aseptic technique is used at times during preparation. The primary rule is ―sterile to sterile‖ and ―unsterile to unsterile.‖ DIF: Cognitive Level: Application REF: p. 129 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Health Promotion

OBJ: 1

Chapter 10: Parenteral Administration: Intradermal, Subcutaneous, and Intramuscular Routes Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. The nurse is educating a patient about diabetes. Which statement, based on recommendations

from the American Diabetes Association, is best regarding site rotation? a. ―Insulin injection sites should always be in the abdomen to ensure absorption into the stomach.‖ b. ―It is important to rotate injection sites systematically within one area before progressing to a new site for injection.‖

c. ―Following exercise, site rotation is not indicated because the circulation in the

muscles will absorb the medication efficiently.‖ d. ―If you aspirate, site rotation can be done every other day to avoid developing

problems with absorption.‖ ANS: B

The American Diabetes Association Clinical Practice recommendations include rotating injections systematically at one site before progressing to another. Insulin is not absorbed into the stomach. Failure to rotate sites can result in lipohypertrophy or lipoatrophy. When subcutaneous (subcut) insulin is administered, aspiration should never be performed.

DIF: Cognitive Level: Comprehension REF: p. 140 OBJ: 2 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education 2. Which technique by the nurse is accurate when administering heparin to a thin, older adult

patient? a. Aspirate before injecting the medication. b. Inject at a 45-degree angle. c. Inject at a 90-degree angle. d. Massage site following injection.

ANS: B

For thin individuals, the skin may need to be pinched and a 45-degree angle used to avoid administration into the muscle. Heparin should never be aspirated. Subcut injections are properly administered at a 45-degree angle. The injection site of heparin should never be massaged.

DIF: Cognitive Level: Application REF: p. 141 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Development

OBJ: 2

3. Which anatomic site would be best for the injection containing 0.5 mL when administering

immunizations to kindergarten students? a. Rectus femoris b. Dorsogluteal c. Deltoid d. Ventrogluteal ANS: C

The deltoid muscle is often used because of its easy access and the fact that it can tolerate 0.5 mL of medication volume. Having the child disrobe is not efficient in this setting.

DIF: Cognitive Level: Comprehension REF: p. 142 | p. 143 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Development 4. A 65-year-old man who weighs 180 lb (81.8 kg) is to receive 1.5 mL of a viscous antibiotic

by intramuscular (IM) injection. Which needle and syringe will be used?

a. 5/8 inch, 25-gauge needle with 5 mL syringe b. 1 inch, 28-gauge needle with 4 mL syringe c. inch, 21-gauge needle with 3 mL syringe d. 3 inch, 16-gauge needle with 1.5 mL syringe ANS: C

It is important to correlate the syringe size to the size of the patient and the tissue mass. The usual amount injected intramuscularly is 0.5 to 2 mL. Needle lengths commonly used for adults are 1 to inches long. A longer needle may be used for a significantly obese adult.

Commonly used needle gauges for IM injections are 20 to 22 gauge. A 5/8 inch, 25-gauge needle is too short and too small to administer a viscous medication. A 1 inch, 28-gauge needle is too small to administer a viscous medication. A 3 inch, 16-gauge needle is too large and too long to administer medication to a patient this size.

DIF: Cognitive Level: Analysis REF: p. 141 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 3 CON: Clinical Judgment | Safety

5. Which site is preferred IM for injecting a 6-month-old child? a. Dorsogluteal b. Abdominal c. Vastus lateralis d. Deltoid muscle ANS: C

The vastus lateralis is generally the preferred IM site in infants because it has the largest muscle mass for that age group. The muscles are not well developed in other areas for this age-group. The dorsogluteal muscle is not developed well enough in a child this age to provide a safe site for injection. The abdominal muscles are not appropriate for IM injection.

The deltoid muscle is not developed well enough in a child this age to provide a safe site for injection.

DIF: Cognitive Level: Knowledge REF: p. 142 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Development

OBJ: 5

6. Which angle is appropriate when administering an IM medication in the dorsogluteal site to a

46-year-old obese man? a. 45 degrees b. 60 degrees c. 75 degrees d. 90 degrees ANS: D

A 90-degree angle is used to reach the IM area of the dorsogluteal site. A 45-, 60-, or 75-degree angle does not ensure that the needle will penetrate to the muscle in an obese patient.

DIF: Cognitive Level: Comprehension REF: p. 144 NAT: NCLEX Client Needs Category: Physiological Integrity

OBJ: 3

TOP: Nursing Process Step: Implementation

CON: Clinical Judgment | Safety

7. Which parenteral route has the longest absorption time? a. Intradermal b. Subcut c. IM d. Intravenous (IV) ANS: A

Absorption rate is determined by the proximity of the medication to the vascular system.

Medication injected into an intradermal site is farther away from the vascular system than the other sites. Therefore, absorption in this site is the slowest. Subcut tissue is more vascular than intradermal tissue. IM tissue is more vascular than intradermal tissue. IV administration places medication directly into the vascular system.

DIF: Cognitive Level: Knowledge REF: p. 137 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Care Coordination 8. Which site is identified by the posterior superior iliac spine and greater trochanter? a. Ventrogluteal b. Dorsogluteal c. Vastus lateralis d. Rectus femoris ANS: B

The dorsogluteal site is identified by drawing an imaginary line from the posterior superior iliac spine to the greater trochanter of the femur. The injection is then administered at any point between the imaginary straight line and below the curve of the iliac crest (hipbone).

DIF: Cognitive Level: Comprehension REF: p. 142 | p. 143 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment 9. Which nursing action is accurate when administering an IM injection using the Z-track

method? a. Use a 1-inch needle. b. Add 0.5 mL of air to the syringe. c. Vigorously massage the injection site. d. Pinch up the skin.

ANS: B

Adding 0.5 mL of air ensures that the drug will clear the needle. A 1-inch needle may not ensure deep muscle penetration. Massaging the injection site could cause the medication to leak into the muscle tissue. The skin should be stretched, not pinched up.

DIF: Cognitive Level: Comprehension REF: p. 145 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation 10. Which gauge needles are used for subcut injections? a. 14- to 16-gauge

OBJ: 3 CON: Clinical Judgment

b. 18- to 21-gauge c. 22- to 24-gauge d. 25- to 29-gauge ANS: D

Commonly used gauges for subcut injection are 25- to 29-gauge needles. Needles that are 14 to 16 gauge are used for administration of blood or large volumes of fluid in a short period of time. Needles that are 18 to 21 gauge are used for routine parenteral fluid administration.

Needles that are 22 to 24 gauge are used for administering fluids or medication via small veins.

DIF: Cognitive Level: Knowledge REF: p. 140 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 2 CON: Clinical Judgment | Safety

11. Which situation is acceptable to use the deltoid muscle as an injection site for infants? a. Medication is irritating. b. Dose is a long-acting medication. c. Child is combative. d. Volume is quite small.

ANS: D

The deltoid site should be used in infants only when the volume is quite small, the medication is nonirritating, and the dose will be quickly absorbed. Irritating and long-acting medications should be injected in deep muscle tissue such as the vastus lateralis. A combative child should be adequately restrained and injected in a fairly large muscle mass.

DIF: Cognitive Level: Comprehension REF: p. 143 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 5 CON: Clinical Judgment | Safety

12. Which action by the nurse is most accurate when administering an intradermal injection? a. Insert the needle at a 45-degree angle. b. Inject 0.1 mL. c. Use a 22-gauge needle. d. Wipe the site with alcohol after injection.

ANS: B

Small volumes, usually 0.1 mL, are injected. The needle is inserted at a 15-degree angle. A 26-gauge needle is used. After injection, the site should not be wiped with alcohol.

DIF: Cognitive Level: Comprehension REF: p. 138 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 CON: Clinical Judgment | Safety

13. Which assessment by the nurse is most important to obtain prior to performing allergy

sensitivity testing? a. Identify areas of loose connective tissue. b. Question the patient about frequency of exercise. c. Determine if the patient is using aspirin. d. Palpate and measure the size of induration.

ANS: C

It is important to determine if the patient has taken any antihistamines or antiinflammatory agents for 24 to 48 hours prior to allergy testing. Loose connective tissue is assessed prior to administering injections subcutaneously. Exercise routine is not significant prior to allergy testing. Palpation and measurement of the size of induration are done after the procedure.

DIF: Cognitive Level: Comprehension REF: p. 137 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 14. Which time is the earliest the nurse can expect to read a skin prick test (SPT) administered to

a patient at 9:00 AM? a. The next day at 9:00 AM. b. By 9:00 PM the same day. c. By 9:10 AM the same day. d. One week from the date and time of administration.

ANS: C

The SPT can be read in 10 to 20 minutes after administration, depending on protocol.

DIF: Cognitive Level: Application REF: p. 139 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Care Coordination

OBJ: 1

15. Which area will the nurse start at when cleansing the skin surface of a patient prior to

injection? a. Periphery and work inward in a back and forth motion. b. Periphery and work inward in a cyclical motion. c. Injection site and work outward in a straight line. d. Injection site and work outward in a circular motion.

ANS: D

The skin surface is cleansed prior to injection starting at the injection site and working outward in a circular motion toward the periphery.

DIF: Cognitive Level: Application REF: p. 144 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Infection

OBJ: 3

MULTIPLE RESPONSE 1. Which statement(s) pertain(s) to preparing to administer allergy sensitivity testing to a

patient? (Select all that apply.) a. Allergy sensitivity testing requires the intradermal route. b. Injections are made into the loose connective tissue. c. Equipment needed includes gloves, antiseptic pledget, metric ruler, and physician‘s order sheet. d. Record of previous injection sites is needed. e. The needle should be inserted at a 15-degree angle with the needle bevel up.

ANS: A, C, E

Allergy sensitivity testing requires the intradermal route. Before administering allergy testing, gathering of equipment and physician‘s orders are necessary. This route is injected into the dermal layer of skin, using a 15-degree angle. Connective tissue, having poor blood supply, is not appropriate for injection of medication. Previous injection sites would not factor into the decision about where to conduct allergy testing.

DIF: Cognitive Level: Comprehension REF: p. 138 | p. 139 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety 2. Which statement(s) about administering medications parenterally is/are true? (Select all that

apply.) a. Subcut absorption is slower than intradermal absorption. b. Two mL or less should be administered in a subcut site. c. The gluteal area is recommended for children. d. Needles 1 to inches in length are common for IM injections. e. The scapular areas of the back may be used for intradermal injections.

ANS: B, D, E

No more than 2 mL of medication should be injected into a subcut site. Needle length of 1 to inches is common for IM injections. The upper chest, scapular areas of the back, and the inner aspect of the forearms are commonly used as sites for intradermal injections.

Subcutaneous absorption is faster than intradermal absorption. Because of the undeveloped muscle mass in children, the gluteal area is not recommended for IM injection.

DIF: Cognitive Level: Knowledge REF: p. 137 | p. 139 | p. 140 OBJ: 1 | 2 | 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety 3. Which category of patient(s) are appropriate to administer injections into the vastus lateralis

muscle? (Select all that apply.) a. Children younger than 3 years of age b. Elderly c. Debilitated d. Nonambulatory e. Ambulatory f. Healthy ANS: A, E, F

Children younger than 3 years of age, ambulatory patients, and otherwise healthy patients may receive injections in the vastus lateralis. Elderly, debilitated, and nonambulatory patients may have reduced muscle mass in the vastus lateralis and therefore poor absorption of injected medications.

DIF: Cognitive Level: Comprehension REF: p. 142 OBJ: 4 | 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Development 4. Which action(s) should be implemented after administering B12 IM to a patient in a long-term

care facility? (Select all that apply.)

a. b. c. d. e.

Carefully recap the needle.

Identify the patient.

Massage site of injection.

Dispose of the used needle according to policy.

Apply a small bandage to the site.

ANS: D, E

After administering an IM injection, the nurse should dispose of used needles according to policy and apply a small bandage to the site. Needles should never be recapped following use.

The patient requires identification before the injection is given. After the needle is removed, gentle pressure should be applied to the site. Massage can increase the pain if the muscle mass is stressed by the amount of medication given.

DIF: Cognitive Level: Application REF: p. 141 | p. 142 OBJ: 3 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety

Chapter 11: Parenteral Administration: Intravenous Route Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which type of intravenous (IV) access device will likely be used for a patient diagnosed with

cancer that requires 6 months of chemotherapy infusions? a. Peripheral venous access device b. Midline catheter c. Winged needle venous access device d. Implantable venous infusion port ANS: D

Implantable venous infusion ports are placed into central veins for long-term therapy.

Chemotherapy treatment is often irritating and best tolerated in the larger central veins.

Peripheral lines are not used for administration of chemotherapy because of the risk of extravasation. A midline catheter is intended only for a 2 to 4 week interval, less than the projected length of time for chemotherapy infusion. Winged needles are for use in peripheral veins that are too small for ongoing infusion of chemotherapy.

DIF: Cognitive Level: Comprehension REF: p. 155 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 4 CON: Clinical Judgment

2. What is the best nursing action when the nurse assesses that a patient with cardiac disease has

IV heparin infusing and that it is behind by 2 hours? a. Increase the IV rate and recheck in 1 hour. b. Change the infusion rate to TKO. c. Discontinue the solution using aseptic technique. d. Contact the healthcare provider for consultation.

ANS: D

The patient has a history of cardiac problems and is receiving a critical care medication, IV heparin. In this case, contacting the patient‘s healthcare provider would be appropriate to avoid harm. Increasing the infusion rate might place the patient into fluid overload and might infuse too much heparin in a short time. Reducing the infusion rate to TKO or discontinuing the solution would put the schedule even further behind.

DIF: Cognitive Level: Application REF: p. 160 OBJ: 6 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Collaboration | Communication 3. Which composition describes hypotonic intravenous solutions such as 0.45% NaCl? a. Fewer dissolved particles than blood b. Approximately the same number of dissolved particles as blood c. Higher concentrations of dissolved particles than blood d. Electrolytes and dextrose ANS: A

Hypotonic solutions have fewer dissolved particles than blood. Half normal saline does not contain dextrose.

DIF: Cognitive Level: Knowledge REF: p. 156 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Fluid and Electrolytes | Cellular Regulation 4. Which condition would the nurse expect to be treated with an isotonic solution? a. Fluid overload b. Hemorrhagic shock c. Cellular dehydration d. Cerebral edema ANS: B

Isotonic solutions have approximately the same osmolality as blood. Isotonic fluids are ideal replacement fluids for patients experiencing an intravascular fluid deficit that occurs in conditions such as acute blood loss from hemorrhage and gastrointestinal bleeding. Isotonic fluids increase vascular volume, thus counteracting hypovolemia and hypotension.

Administering isotonic solutions for fluid overload would exacerbate the problem. Hypotonic solutions are administered for cellular dehydration. Hypertonic solutions are administered for cerebral edema.

DIF: Cognitive Level: Comprehension REF: p. 156 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Fluid and Electrolytes | Cellular Regulation 5. The nurse determines that an elderly patient‘s IV of D50.2 NS with 20 mEq KCl at 75 mL/hr

is running 3 hours behind. Which action will the nurse take after determining the IV site is patent? a. Call the healthcare provider to obtain an order to decrease the IV rate. b. Administer a bolus to make up the deficit. c. Recalculate the flow rate and slowly make up the fluids.

d. Maintain the ordered rate.

ANS: D

The safest action is to maintain the ordered rate. The healthcare provider should be consulted if the patient has not received critical IV replacement therapy. Increasing an IV rate without a healthcare provider‘s order can be detrimental for patients who have cardiac, renal, or circulatory impairment. Normal aging process results in decreased cardiac, renal, and circulatory function. The rate ordered is the one the provider intended for the administration of fluids; changing it to fit the prevailing situation is not appropriate. The bolus technique should only be used for the administration of medications or fluid challenges in patients who need a volume of IV fluid quickly. The flow rate must be consistent with the provider‘s order.

DIF: Cognitive Level: Application REF: p. 160 OBJ: 6 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Fluid and Electrolytes | Cellular Regulation 6. Which technique by the nurse accurately maintains asepsis of a peripheral IV access device? a. Wear gloves when hanging all IV solutions. b. Apply a topical antibiotic ointment to the insertion site. c. Change fluid administration sets according to institutional policy. d. Flush with heparin before use.

ANS: C

Generally all IV solution bag and bottles should be changed every 24 hours to minimize the development of new infections. IV administration sets used to deliver blood and blood products are changed after each unit is administered. Administration sets to deliver lipids and TPN are often changed every 4 hours, whereas administration sets for maintenance fluids may be changed every 72 hours. It is important to follow institutional policies. All IV bags, bottles, and administration sets should be labeled with the date, time, and nurse‘s initials of the set change. Wearing gloves is not required for maintenance of routine infusion. Topical antibiotics may promote fungal infections and antimicrobial resistance. A peripheral line that is infusing should not need an anticoagulant to maintain patency.

DIF: Cognitive Level: Comprehension REF: p. 159 OBJ: 6 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Infection | Health Promotion 7. Which needle is used to access implanted infusion devices? a. Jamshidi b. Huber c. Gigli d. Crutchfield ANS: B

The Huber needle is a special non-coring 90-degree needle used to penetrate the skin and septum of the implanted device. The Jamshidi needle is used for biopsy purposes such as bone marrow. The Gigli saw is a wire with serrations used to cut through cranial bone. Crutchfield tongs are used to stabilize the cervical spine by traction in cases of fracture.

DIF: Cognitive Level: Knowledge

REF: p. 155

OBJ: 5

NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

CON: Clinical Judgment

8. Which complication is this patient most likely experiencing when the nurse assesses

erythema, warmth, and burning pain along the patient‘s IV site? a. Air embolism b. Extravasation c. Phlebitis d. Pulmonary edema ANS: C

Erythema, warmth, and tenderness along the course of the vein and swelling are signs of phlebitis. Air embolism occurs as a result of an air bubble entering the vascular system, and shortness of breath, chest pain, and hypotension are indicative of this complication.

Extravasation is the leakage of an irritant and is accompanied by redness, warmth or coolness, swelling, and a dull ache to severe pain at the venipuncture site. Pulmonary edema is caused by fluid infusing too rapidly; dyspnea, cough, anxiety, rales, and possible cardiac dysrhythmias are indicative of pulmonary edema.

DIF: Cognitive Level: Comprehension REF: p. 174 OBJ: 7 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety | Infection | Tissue Integrity | Perfusion 9. An elderly patient receiving an infusion of an isotonic fluid at 100 mL/hr complains of

dyspnea. The nurse notes shallow rapid respirations and a cough that produces frothy sputum.

Which is the priority nursing action? a. Assess the urine output. b. Elevate the head of the bed. c. Encourage the patient to cough. d. Maintain the IV rate.

ANS: B

Elevating the head of the bed is an appropriate action for signs and symptoms of pulmonary edema. Urine output is important to assess, but it is not the priority nursing action.

Encouraging the patient to cough and take deep breaths is not the priority nursing action. The IV rate should be slowed immediately based on the signs and symptoms the patient is displaying.

DIF: Cognitive Level: Application REF: p. 176 OBJ: 7 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Fluid and Electrolytes | Perfusion 10. Which system would most likely be used when a patient diagnosed with diabetes requires the

administration of insulin continuously at home? a. Central line catheter b. Microdrip set c. Piggyback system d. Syringe pump ANS: D

Syringe pumps are used in patients with diabetes. A central line is not appropriate for the diabetic patient requiring insulin. A microdrip set is a type of IV tubing that is used when small volumes of fluid are given to patients with fluid volume concerns. A piggyback system is a type of administration set that connects to a primary setup and administers a small volume over 20 to 60 minutes.

DIF: Cognitive Level: Comprehension REF: p. 152 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 5 CON: Clinical Judgment | Safety

11. A patient is admitted with hypovolemia resulting from lack of fluid intake and requires an

infusion of isotonic fluids. Which IV solution will the nurse administer? a. D50.2 NS b. D5W c. 0.45 NS d. 0.9 NS ANS: D

0.9 NS is an isotonic solution appropriate for hypovolemia. D50.2 NS, D5W, and 0.45 NS are hypotonic solutions.

DIF: Cognitive Level: Comprehension REF: p. 156 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Fluid and Electrolytes | Cellular Regulation 12. Which potential complication will the nurse expect in patients with a venous access device? a. Circulatory overload b. Extravasation c. Infection d. Pain ANS: C

Because venipuncture alters skin integrity, the patient is vulnerable to infection at all times.

Circulatory overload is a concern but does not occur with any type of venous access device because the device may just be used for administration of small volumes of drugs (e.g., chemotherapy in cancer patients). Extravasation is a potential complication when there is infusion of an irritating chemical. IV drug administration is usually more comfortable for patients than other routes, and pain would not be considered a complication.

DIF: Cognitive Level: Comprehension REF: p. 174 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Infection | Tissue Integrity

OBJ: 7

13. Which time period identifies how long, with proper care, a peripherally inserted central

catheter (PICC) line inserted to continue IV antibiotic therapy at home can remain in place? a. 2 months b. 4 months c. 6 months d. 12 months

ANS: D

PICC lines routinely remain in place for 1 to 3 months but can last for a year or more if cared for properly.

DIF: Cognitive Level: Knowledge REF: p. 154 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Infection | Tissue Integrity

OBJ: 1 | 6

14. Which sign or symptom indicates that the patient with a central venous access device is

experiencing an air embolism? a. Chest pain b. Erythema c. Frothy sputum d. Sweating ANS: A

Chest pain is a symptom associated with air embolism. Erythema occurs with infiltration or extravasation. Frothy sputum occurs with circulatory overload or pulmonary edema. Sweating is indicative of a pulmonary embolism.

DIF: Cognitive Level: Comprehension REF: p. 176 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Perfusion | Gas Exchange

OBJ: 7

15. Following the insertion of a central venous access device, the nurse notes a weak, thready

pulse and decreased blood pressure. The patient complains of shortness of breath and palpitations. Which action will the nurse take first? a. Place the patient on the left side. b. Reassess vital signs. c. Stop the infusion. d. Verify placement of the device.

ANS: A

Signs and symptoms indicate an air embolism. The nurse‘s immediate action will be to place the patient onto his or her left side. The nurse has determined change in pulse and blood pressure already, and although it is appropriate to reassess, it is not the first action the nurse will take. There is no indication that anything is infusing into this venous access device.

Verifying the placement of the device is not the first action the nurse would take.

DIF: Cognitive Level: Application REF: p. 176 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Perfusion | Gas Exchange

OBJ: 7

16. Which action will the nurse take first when administering a prescribed medication IV push

into a patient‘s Hickman catheter? a. Administer the prescribed drug. b. Flush with saline. c. Flush with heparin. d. Prepare a pump.

ANS: B

Drugs given by IV push or bolus through a Hickman catheter generally follow the SASH guideline: saline flush first; administer the prescribed drug; saline flush following the drug; and heparin flush line. A pump is not used when a drug is administered by push technique.

DIF: Cognitive Level: Application REF: p. 160 OBJ: 6 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Health Promotion 17. A 90-year-old woman is admitted to an acute care facility with the diagnosis of pneumonia.

She has a past medical history of diabetes mellitus, hypertension, and right-sided mastectomy.

Which action will the nurse take when starting an IV for infusion of antibiotic therapy? a. Insert the IV catheter into the left hand. b. Use a lower extremity vein for insertion. c. Choose the left radial artery for insertion. d. Attempt insertion into the left antecubital space vein.

ANS: D

IV insertion should not be initiated in an arm with compromised lymphatic or venous flow such as a mastectomy. The left antecubital space vein would be a good choice for this patient given her age and medical history. In the older adult, using the veins in the hand area may be a poor choice because of the fragility of the skin and veins in this area. When possible, the veins of the lower extremities should be avoided for IV insertion because of the danger of developing thrombi and emboli. IV therapy should never be started in an artery.

DIF: Cognitive Level: Application REF: p. 160 OBJ: 3 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Perfusion | Tissue Integrity MULTIPLE RESPONSE 1. Which information will the nurse explain when teaching a patient about a PICC line? (Select

all that apply.) a. The catheter may have a single or double lumen. b. There is greater risk of clotting and infiltration with this type of catheter. c. The patient will be receiving infusions continuously to ensure patency. d. The tip of the catheter may be open or valved. e. The catheter may be used for drawing blood.

ANS: A, D

PICC lines may have more than one lumen. The catheter may have an open tip or a valved (Groshong) tip. The risk of infiltration and clotting is less than with other types of central lines. The line should be flushed with a saline heparin solution after every use, or daily, in order to maintain patency if it is not in continuous use. PICC lines are not appropriate for blood drawing because of their small size.

DIF: Cognitive Level: Comprehension REF: p. 154 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1

CON: Clinical Judgment | Patient Education 2. Which patient assessment finding(s) suggest(s) extravasation of an IV solution? (Select all

that apply.) a. Coolness b. Edema c. Fever d. Pain at venipuncture site e. Redness at the site f. Shortness of breath ANS: A, B, D, E

Coolness, edema, pain, and redness are indicative of extravasation. Fever does not indicate extravasation. Shortness of breath does not indicate extravasation.

DIF: Cognitive Level: Comprehension REF: p. 175 OBJ: 7 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Tissue Integrity 3. Which nursing action(s) is/are appropriate when assessing a patient‘s right had IV site that is

infiltrated?(Select all that apply.) a. Stopping the infusion b. Attempting to aspirate the medication c. Elevating the affected limb d. Checking capillary refill e. Removing the catheter as directed by policy ANS: A, C, D, E

For an infiltration, stop the infusion. Elevate the affected limb. Assess for circulatory compromise; check capillary refill and pulses proximal and distal to the area of infiltration. If the infiltration is caused by an IV solution, remove the catheter as directed by policy. For extravasation, attempts may be made to aspirate the medication.

DIF: Cognitive Level: Application REF: p. 175 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Tissue Integrity

OBJ: 7

Chapter 12: Drugs Affecting the Autonomic Nervous System Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which condition would alert the nurse of the need to use beta-adrenergic blockers cautiously? a. Hypertension b. Raynaud‘s phenomenon c. Emphysema d. Cardiac dysrhythmias ANS: C

Beta-adrenergic blockers can produce severe bronchoconstriction. Selective beta 1 antagonists are used to treat hypertension. Alpha-adrenergic blocking agents are used to treat patients with Raynaud‘s disease. Beta-adrenergic blocking agents are indicated for patients with cardiac arrhythmias.

DIF: Cognitive Level: Comprehension REF: p. 185 | p. 187 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Perfusion | Care Coordination 2. Which explanation by the nurse is most accurate when a patient with chronic obstructive

pulmonary disease (COPD) reports having insomnia and a racing heart after starting terbutaline therapy? a. ―The symptoms are typical and indicate that the medication is at a therapeutic level.‖ b. ―The symptoms will tend to resolve with continued therapy.‖ c. ―The symptoms are unusual and need to be reported to the healthcare provider immediately.‖ d. ―The symptoms are indicative of toxicity.‖ ANS: B

Terbutaline, an adrenergic agent effective for bronchodilation, can cause excessive central nervous system (CNS) stimulation. Adverse effects such as palpitations, tachycardia, flushed skin, dizziness, and tremors tend to be mild and resolve with continued therapy. The therapeutic level can only be determined by analyzing a blood sample. These are common symptoms and should only be reported if they persist. Symptoms of toxicity are chest pain, persistent palpitations, and tachycardia.

DIF: Cognitive Level: Application REF: p. 182 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety | Perfusion | Gas Exchange | Patient Education 3. Which response is the primary response to alpha-1–receptor stimulation? a. Bronchodilation b. Tachycardia c. Vasoconstriction d. Uterine relaxation ANS: C

Stimulation of the alpha-1 receptors causes vasoconstriction of all blood vessels throughout the body. Alpha-1–receptor stimulation causes bronchoconstriction. Alpha-1–receptor stimulation does not cause tachycardia. Beta-2–receptor stimulation produces relaxation of smooth muscle tissue, such as the uterus.

DIF: Cognitive Level: Knowledge REF: p. 181 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Perfusion 4. Which category of medications is used for peripheral vascular diseases characterized by

excessive vasoconstriction, such as Raynaud‘s disease?

a. b. c. d.

Adrenergic agents Alpha-adrenergic blocking agents Beta-adrenergic blocking agents Cholinergic agents

ANS: B

Alpha-adrenergic blocking agents interfere with the stimulation of alpha-1 and alpha-2 receptors. Because the primary action of alpha-receptor stimulation is vasoconstriction, alpha-adrenergic blocking agents are indicated for patients with diseases associated with vasoconstriction. Adrenergic drugs cause vasoconstriction. Beta-adrenergic blocking agents are used to treat hypertension and dysrhythmias. Cholinergic drugs are used to treat ocular diseases such as glaucoma, respiratory tract disease, and urinary system diseases.

DIF: Cognitive Level: Comprehension REF: p. 181 | p. 185 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Perfusion 5. Which explanation provides rationale for why beta blockers are used cautiously in patients

with respiratory conditions? a. Mask the signs and symptoms of acute hypoglycemia. b. Cause extensive vasodilation and cardiac overload. c. May produce severe bronchoconstriction. d. Increase hypertensive episodes.

ANS: C

Nonselective beta blockers, such as Inderal, and larger doses of selective beta antagonists will readily affect the beta-2 receptors of the bronchi, causing bronchoconstriction. Therefore, beta blockers must be used with extreme caution in patients with respiratory conditions such as bronchitis, emphysema, asthma, or allergic rhinitis. Beta blockers affect blood glucose by inducing the hypoglycemic effects of insulin. Vasodilation relieves cardiac overload. Beta blockers induce hypotensive effects.

DIF: Cognitive Level: Comprehension REF: p. 185 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Perfusion | Gas Exchange

OBJ: 2

6. Which response by the nurse is most accurate when a patient with the diagnosis of

Parkinson‘s disease asks the nurse why anticholinergics are used in the treatment? a. ―These drugs help you urinate.‖ b. ―These drugs will decrease your eye pressure.‖ c. ―These drugs inhibit the action of acetylcholine.‖ d. ―These drugs will assist in lowering your heart rate.‖ ANS: C

Anticholinergic agents inhibit the action of acetylcholine in the parasympathetic nervous system. These drugs occupy receptor sites at the parasympathetic nerve endings, preventing the action of acetylcholine. Inhibition of acetylcholine facilitates stimulation of the dopaminergic receptors, which relieves the symptoms associated with Parkinson‘s disease.

Anticholinergic agents cause urinary retention, increase intraocular pressure, and increase the heart rate.

DIF: Cognitive Level: Comprehension REF: p. 188 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 3

7. Which condition is important to screen a patient for before the initiation of anticholinergic

medications? a. Hypertension b. Infectious diseases c. Diabetes d. Closed-angle glaucoma ANS: D

The inhibition of cholinergic activity (anticholinergic effects) causes pupil dilation, which increases intraocular pressure in patients with glaucoma. In patients with closed-angle glaucoma, anticholinergic medications can precipitate an acute attack. Anticholinergic agents may produce increased heart rate but not hypertension. Anticholinergic agents do not affect infections or diabetes.

DIF: Cognitive Level: Comprehension REF: p. 188 OBJ: 3 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Perfusion | Health Promotion 8. Which nerve endings liberate norepinephrine? a. Cholinergic b. Adrenergic c. Anticholinergic d. Muscarinic ANS: B

Nerve endings that secrete norepinephrine are called adrenergic fibers. These nerve endings liberate acetylcholine. Anticholinergic describes the action of certain medications that inhibit the transmission of parasympathetic nerve impulses and thereby reduce spasms of smooth muscle (e.g., as in the bladder). Muscarinic receptors are those membrane bound acetylcholine receptors that are more sensitive to muscarine than to nicotine.

DIF: Cognitive Level: Knowledge REF: p. 181 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 9. Which types of adrenergic receptors subdivide the autonomic nervous system? a. Nicotinic and muscarinic b. Afferent and efferent c. Alpha and beta d. Agonists and antagonists ANS: C

The autonomic nervous system can be subdivided into alpha- and beta-adrenergic receptors.

Nicotine and muscarine are specific agonists of one type of cholinergic receptor. Afferent and efferent are sensory and motor nerves. An agonist is a molecule that activates a receptor by reproducing the effect of the neurotransmitter. An antagonist acts against and blocks a function.

DIF: Cognitive Level: Knowledge REF: p. 181 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 10. Which is most important for the nurse to assess prior to the administration of metoprolol, a

beta-adrenergic blocking agent? a. Blood pressure b. Lung sounds c. Mental status d. Urine output ANS: A

Beta-adrenergic blocking agents cause vasodilation and decreased heart rate, resulting in lowering of the blood pressure. A premedication assessment is to take baseline heart rate and blood pressure. Fluid retention may occur as a serious adverse effect but is not the most important assessment prior to the administration of a beta-adrenergic blocking agent. Mental status and urine output are not the most important assessments prior to the administration of a beta-adrenergic blocking agent.

DIF: Cognitive Level: Application REF: p. 185 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Perfusion 11. Which statement by the patient indicates a need for further teaching when a patient with a

history of type 1 diabetes after myocardial infarction has been placed on a beta-adrenergic blocking agent? a. ―This medication should not be discontinued suddenly.‖ b. ―This medication lowers my blood pressure by helping me get rid of fluid.‖ c. ―I may not have my usual symptoms of a hypoglycemic reaction while on this drug.‖ d. ―This medication may take a few weeks to work.‖ ANS: B

Beta-adrenergic blocking agents decrease the heart rate and dilate blood vessels to lower blood pressure. Sudden discontinuation of beta-adrenergic blocking agents may result in an exacerbation of angina symptoms. Beta-adrenergic blocking agents may mask symptoms of hypoglycemia. Beta-adrenergic blocking agents may take several days to weeks to show optimal improvement.

DIF: Cognitive Level: Application REF: p. 185 | p. 187 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety | Patient Education | Perfusion

12. An older adult patient is to receive atenolol, a beta-adrenergic blocking agent. Prior to

administration of the drug, the nurse assesses an apical pulse rate of 58 and notes ankle edema. Which action will the nurse take first? a. Determine the therapeutic blood level. b. Encourage the patient to decrease water intake. c. Elevate the patient‘s legs. d. Withhold the medication.

ANS: D

These signs and symptoms are indicative of serious adverse effects, and the medication should be held or discontinued until the patient is evaluated by a healthcare provider. Determining the therapeutic blood level, encouraging the patient to decrease water intake, and elevating the patient‘s legs are not the first actions that should be taken.

DIF: Cognitive Level: Application REF: p. 185 | p. 187 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Cellular Regulation | Perfusion 13. Which action is the most appropriate to take when a patient hospitalized in an acute care

setting reports to the nurse that since starting on an adrenergic medication, he has been feeling ―dizzy and weak‖? a. Immediately notify the physician. b. Teach the patient to move slowly from standing to sitting. c. Discontinue the adrenergic blocker. d. Monitor the blood pressure in both the supine and standing positions.

ANS: D

Although infrequent and generally mild, adrenergic agents may cause some degree of orthostatic hypotension manifested by dizziness and weakness, particularly when therapy is initiated. This is anticipated and does not require the physician to be immediately notified.

DIF: Cognitive Level: Application REF: p. 183 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Perfusion

OBJ: 6

14. A. Which priority nursing action needs to be implemented when a long-term care resident

taking an anticholinergic agent is observed to be disoriented and hallucinating? a. Report development of alterations to the charge nurse. b. Assess blood glucose. c. Provide for resident‘s safety. d. Medicate with antianxiety medication.

ANS: C

Serious psychological side effects of anticholinergic agents include confusion, depression, nightmares, and hallucinations. The priority nursing action at onset of confusion and hallucinations is safety. Once the resident is safe, development of alterations may be reported.

Blood glucose may be monitored once safety is established. If appropriate medications are ordered by the physician, they can be provided once the resident is calm and safe.

DIF: Cognitive Level: Analysis

REF: p. 189

OBJ: 3

NAT: NCLEX Client Needs Category: Safe, Effective Care Environment | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Perfusion | Mood and Affect | Sensory Perception 15. Which is the best action for the nurse to take when auscultating inspiratory and expiratory

wheezing bilaterally on a patient taking a cholinergic agent? a. Provide the next dose of the cholinergic agent immediately. b. Assess heart rate and blood pressure. c. Reposition the patient. d. Withhold the next dose and notify the physician.

ANS: D

Serious respiratory adverse effects of cholinergic agents include bronchospasm and wheezing.

If these symptoms present, the next dose of the cholinergic agent should be withheld until the patient is evaluated by a healthcare provider.

DIF: Cognitive Level: Application REF: p. 188 OBJ: 5 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Perfusion | Gas Exchange MULTIPLE RESPONSE 1. Which adverse effect(s) is/are common when a patient is receiving a cholinergic agent?

(Select all that apply.) a. Nausea b. Hypertension c. Dizziness d. Bradycardia e. Constipation ANS: A, C, D

Cholinergic agents produce effects similar to those of acetylcholine. Cholinergic actions increase gastrointestinal (GI) motility and secretions that can cause nausea, vomiting, diarrhea, and abdominal cramping. GI symptoms tend to be dose related and may be controlled by decreasing the dosage. Dizziness is a common adverse effect and can be minimized by rising slowly from a sitting or supine position. Cholinergic agents slow the heart rate, have a hypotensive effect, increase GI motility, and result in diarrhea and cramping.

DIF: Cognitive Level: Knowledge REF: p. 187 | p. 188 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety 2. Which statement(s) is/are true about efferent nerves? (Select all that apply.) a. Transmit signals to the spinal cord and brain. b. Leave the CNS to carry impulses to other body parts. c. Are part of the peripheral nervous system. d. Transmit signals that control contractions of smooth and skeletal muscles. e. Transmit signals that control contractions of some glandular secretions.

ANS: B, C, D, E

Efferent nerves leave the CNS and carry impulses to other body parts that control contractions of smooth and skeletal muscles, as well as some glandular secretions. The efferent nerves, together with afferent nerves, make up the peripheral nervous system.

DIF: Cognitive Level: Comprehension REF: p. 180 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 3. Which instruction(s) given by the nurse will assist a patient to cope with the common adverse

effects of anticholinergic medications? (Select all that apply.) a. ―Take the medication with meals.‖ b. ―Increase fluids daily.‖ c. ―Decrease fiber in the diet.‖ d. ―Suck on candy or ice chips.‖ e. ―Monitor blood glucose.‖ ANS: B, D

Anticholinergic medications cause dryness of mucous membranes. Increasing fluids, sucking on candy or ice chips, or chewing gum helps alleviate the dryness of the mouth, nose, and throat. Taking the medication with meals and decreasing fiber in the diet will not help patients cope with the adverse effects. Anticholinergics do not affect blood glucose levels.

DIF: Cognitive Level: Comprehension REF: p. 189 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education

OBJ: 3

4. Which body function(s) is/are controlled by the autonomic nervous system? (Select all that

apply.) a. Blood pressure b. Skeletal muscle contraction c. GI secretion d. Body temperature e. Urination ANS: A, C, D, E

Blood pressure, GI secretion, body temperature, and urinary bladder function are body functions controlled by the autonomic nervous system. The autonomic nervous system maintains control over most tissue function, with the exception of skeletal muscle.

DIF: Cognitive Level: Knowledge REF: p. 180-181 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 5. Which common adverse effect(s) will the nurse include in discharge teaching for a patient on

an adrenergic bronchodilator? (Select all that apply.) a. Palpitations b. Dizziness c. Orthostatic hypotension d. Hypoglycemia e. Tremors

f.

Bradycardia

ANS: A, B, C, E

Common adverse effects of adrenergic agents are palpitations, rapid heart rate, dizziness, orthostatic hypotension, and tremors. Adrenergic agents may cause hyperglycemia in the patient with diabetes mellitus. Adrenergic agents may cause tachycardia, not bradycardia, in the patient.

DIF: Cognitive Level: Comprehension REF: p. 182 | p. 183 OBJ: 6 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education 6. Which terms identify neurotransmitter(s)? (Select all that apply.) a. Gamma aminobutyric acid b. Acetylcholine c. Serotonin d. Glucose e. Histamine f. Epinephrine ANS: A, B, C, E, F

The CNS is composed of systems of different types of neurons that secrete separate neurotransmitters. Gamma aminobutyric acid, acetylcholine, serotonin, histamine, and epinephrine are examples. Glucose is a sugar that is the body‘s main source of energy.

DIF: Cognitive Level: Knowledge REF: p. 181 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 7. Which disorder(s) would indicate the use of anticholinergic agents? (Select all that apply.) a. Glaucoma b. Benign prostatic hypertrophy c. Bradycardia d. Parkinson‘s disease e. Preparation for surgery f. Stimulation of the vagus nerve ANS: C, D, E

Anticholinergic drugs are used to treat bradycardia and Parkinson‘s disease and are used as drying agents in preparation for surgery and anesthetic administration. Anticholinergic drugs are not used to treat glaucoma, are contraindicated in cases of prostatic hypertrophy, and block vagal stimulation.

DIF: Cognitive Level: Comprehension REF: p. 188 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Health Promotion

Chapter 13: Drugs Used for Sedation and Sleep Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE

1. Which initial action should the nurse take when finding a patient extremely agitated, yelling

frequently, and attempting to get out of bed without assistance? a. Administer zolpidem after taking the patient‘s vital signs. b. Close the patient‘s door for privacy after administering Tylenol. c. Administer benzodiazepine before calling the healthcare provider. d. Spend uninterrupted time listening to the patient.

ANS: D

Assessing the patient‘s level of anxiety is important. The patient may only need someone to listen to what stressors he or she is facing. The nurse must assess the patient before medication can be administered.

DIF: Cognitive Level: Application REF: p. 195 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Anxiety 2. An older adult patient received a hypnotic agent at 9:00 PM. At 2:00 AM, the nurse discovers

that the patient has removed her gown and is attempting to get out of bed without assistance.

Which type of medication effect is the patient exhibiting? a. Allergic b. Hypersensitivity c. Paradoxical d. Therapeutic ANS: C

A paradoxical effect may occur in older adult patients. This includes periods of excitement, confusion, restlessness, and euphoria. Allergies to medications tend to manifest in skin or respiratory symptoms. A patient who is hypersensitive to a hypnotic would be difficult to rouse. A therapeutic effect for a hypnotic would be sedation.

DIF: Cognitive Level: Comprehension REF: p. 201 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety | Sensory Perception 3. Which condition indicates the need for benzodiazepines to be prescribed? a. Chronic amnesia b. Chronic insomnia c. Preoperative sedation d. Psychotic episode ANS: C

The sedative-hypnotic effect of benzodiazepines facilitates surgical sedation. Short-acting benzodiazepines are administered intramuscularly for preoperative sedation. They are also given intravenously for conscious sedation before short diagnostic procedures or for the induction of general anesthesia. Benzodiazepines are not recommended for long-term use and do not affect amnesia. Benzodiazepines are a poor choice for the treatment of chronic insomnia because of their risk for habituation. Benzodiazepines do not have an antipsychotic effect.

DIF: Cognitive Level: Knowledge REF: p. 196 NAT: NCLEX Client Needs Category: Physiological Integrity

OBJ: 3

TOP: Nursing Process Step: Assessment

CON: Clinical Judgment

4. Which type of blood work will be performed when a patient receiving diazepam (Valium) is

complaining of nausea and vomiting and is becoming jaundice? a. Renal function tests b. Liver function tests c. Clotting times d. Electrolyte panels ANS: B

Liver function tests will be performed because nausea, vomiting, and jaundice can be indicative of hepatotoxicity. Abnormal liver function test results (i.e., elevated bilirubin, aspartate transaminase [AST], alanine transaminase [ALT], gamma-glutamyl transferase [GGT], and alkaline phosphatase levels, as well as prothrombin time) are indicative of hepatotoxicity. Benzodiazepines do not affect the kidneys, clotting times, and electrolytes.

DIF: Cognitive Level: Comprehension REF: p. 198 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 5 CON: Clinical Judgment | Safety

5. Which benefit applies to the use of sedatives? a. Increased pain control postoperatively b. Reduced bronchial secretions c. Decreased patient anxiety d. Increased patient alertness ANS: C

Preoperatively, sedatives will help decrease patient anxiety and facilitate sleep. Sedatives are not long acting enough to affect postoperative pain control. Sedatives do not affect bronchial secretions. Sedatives diminish patient alertness.

DIF: Cognitive Level: Knowledge REF: p. 194 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment 6. Which two phases make up normal sleep? a. Hypnagogic and hypnopompic b. Rapid eye movement (REM) and non REM c. Alpha and beta d. Delta and theta ANS: B

Normal sleep can be divided into two phases, REM and non REM. Hypnagogic is the state between waking and sleeping; hypnopompic is the transition between sleeping and waking states. Beta waves are those associated with day to day wakefulness. During periods of relaxation while still awake, our brain waves become slower, increase in amplitude, and become more synchronous. These types of waves are called alpha waves. The first stage of sleep is characterized by theta waves. During a normal night‘s sleep, a sleeper passes from the theta waves of stages 1 and 2 to the delta waves of stages 3 and 4. Delta waves are the slowest and highest amplitude brain waves.

DIF: Cognitive Level: Knowledge

REF: p. 192

OBJ: 1

NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 7. Which sleep pattern stage diminishes as an effect of aging? a. Stage I b. Stage II c. Stage III d. Stage IV ANS: D

As we age, stage IV sleep diminishes. Many people older than 75 years do not demonstrate any stage IV sleep patterns. Between 2% and 5% of sleep is stage I. Stage II comprises about 50% of normal sleep time. Stage III is a transition between lighter sleep and deeper sleep.

DIF: Cognitive Level: Knowledge REF: p. 193 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Health Promotion 8. Which action will the nurse take when a patient has been prescribed lorazepam (Ativan)? a. Advise the patient to take the medication with food. b. Assess the patient‘s blood pressure in sitting and lying positions. c. Inform the patient to discontinue the medication once sleep improves. d. Instruct the patient to lie down before taking the medication.

ANS: B

Measuring blood pressure in sitting and lying positions is important to assess for transient hypotension. Ativan does not have to be taken with food. Rapid discontinuance of the medication after long-term use may result in symptoms similar to those of alcohol withdrawal.

Gradual withdrawal of benzodiazepines is over 2 to 4 weeks. Medications should be taken sitting up.

DIF: Cognitive Level: Application REF: p. 196 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Health Promotion

OBJ: 3

9. Which disease is associated with insufficient sleep? a. Cancer b. Glaucoma c. Myocardial infarction d. Renal failure ANS: C

Individuals who sleep less than 5 hours a night have a threefold increased risk of heart attacks.

Cancer, glaucoma, and renal failure are not associated with lack of sleep.

DIF: Cognitive Level: Knowledge REF: p. 192 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Health Promotion

10. The nurse is caring for an older patient recently admitted to an assisted living center who is

experiencing insomnia associated with the recent relocation. Which nursing action will assist the patient to sleep? a. Offering the patient hot tea b. Encouraging the patient to ambulate in the hallway c. Performing back massage d. Administering an analgesic ANS: C

Providing a back rub will promote relaxation and reduce anxiety associated with a new environment. This would also provide an opportunity for the nurse to encourage the patient to express feelings. The patient should avoid products containing caffeine, such as coffee, tea, soft drinks, and chocolate. A quiet unwinding activity before bedtime is helpful for sleep promotion. Administering an analgesic is not an appropriate action.

DIF: Cognitive Level: Application REF: p. 195 OBJ: 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Caregiving 11. Which statement about sedatives is true? a. A sedative will produce sleep. b. Sedatives increase the total time in REM sleep. c. Increased relaxation occurs with sedatives. d. Sedatives are more potent than hypnotics.

ANS: C

A hypnotic is a drug that produces sleep; a sedative quiets the patient and gives a feeling of relaxation and rest, not necessarily accompanied by sleep. Sedatives do not increase the total time in REM sleep. A small dose of a drug may act as a sedative, whereas a larger dose of the same drug may act as a hypnotic and produce sleep.

DIF: Cognitive Level: Comprehension REF: p. 194 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Patient Education 12. The nurse is assessing a patient who is being evaluated in an outpatient clinic for complaints

of back pain. The patient reports taking diphenhydramine for insomnia related to job stress.

Which statement by the nurse is accurate regarding this medication? a. ―This medication should only be taken for 1 week.‖ b. ―This medication can cause nausea.‖ c. ―The medication should not be taken after eating a high-fat meal.‖ d. ―This is an herbal medication that has been used for hundreds of years.‖ ANS: A

Antihistamines (particularly diphenhydramine and doxylamine) have sedative properties that may be used for short-term treatment of mild insomnia. They are common ingredients in over-the-counter (OTC) sleep aids. Tolerance develops after only a few nights of use; increasing the dose actually causes a more restless and irregular sleep pattern.

Diphenhydramine does not cause nausea. There is no restriction on taking diphenhydramine after a high-fat meal. Diphenhydramine is not an herbal medication.

DIF: Cognitive Level: Comprehension REF: p. 198 | p. 199 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education 13. When reviewing a patient‘s history and physical information, the nurse notes that the patient

has physician‘s orders for chloral hydrate and warfarin. During assessment of this patient, the nurse observes areas of petechiae and ecchymosis on the upper and lower extremities. Which lab work is most appropriate for the nurse to assess next? a. Liver function studies b. C-reactive protein c. Sedimentation rate d. Prothrombin time ANS: D

Chloral hydrate may enhance the anticoagulant effects of warfarin. The patient should be observed for petechiae, ecchymoses, nosebleeds, bleeding gums, dark tarry stools, and bright red or coffee-ground emesis. Prothrombin time should be monitored, and the physician should reduce the dosage of warfarin, if necessary.

DIF: Cognitive Level: Application REF: p. 198 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 5 CON: Clinical Judgment | Safety

14. Which information should be included when providing patient education on ramelteon

(Rozerem)? a. Thoroughly chew . b. Do not take with a high fat meal. c. Take on an empty stomach. d. Take only before bedtime.

ANS: B

Ramelteon (Rozerem) is available in tablet form and should not be taken with or immediately after a high fat meal.

DIF: Cognitive Level: Comprehension REF: p. 199 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 3

MULTIPLE RESPONSE 1. Which explanation is correct in identifying why benzodiazepines are often preferred over

barbiturates? (Select all that apply.) a. They have selective action at specific receptor sites. b. There is a wide range of safety between therapeutic and lethal levels. c. REM sleep is decreased to a lesser extent. d. Accidental overdoses are well tolerated. e. There are no hypotensive episodes when rising to a sitting position.

ANS: A, B, C, D

The selectivity of specific drugs at receptor sites accounts for the wide variety of uses. There is a wide safety margin between the therapeutic and lethal dosages for these drugs.

Benzodiazepines decrease REM sleep to a lesser extent. Intentional and unintentional overdoses of benzodiazepines are often well tolerated and not fatal. There are transient hypotensive episodes with benzodiazepine therapy.

DIF: Cognitive Level: Comprehension REF: p. 195 | p. 196 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Health Promotion 2. Which common adverse effect(s) apply(ies) to barbiturates? (Select all that apply.) a. Residual daytime sedation b. Headache c. Hyperactivity d. Blurred vision e. Impaired coordination ANS: A, B, D, E

The long half-life of a barbiturate medication often causes residual daytime sedation.

Headache is a general adverse effect of barbiturates. Blurred vision is an adverse effect associated with the hypnotic dosages of long-acting barbiturates. Impaired coordination is an adverse effect of barbiturates. Hyperactivity is not generally an adverse effect of barbiturates unless the patient is experiencing a paradoxical response.

DIF: Cognitive Level: Knowledge REF: p. 195 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Patient Education | Safety 3. Which effect(s) can occur as a result of rapid withdrawal from long-term use of

benzodiazepine therapy? (Select all that apply.) a. Anxiety b. Delirium c. Weakness d. Grand mal seizures e. Severe pain ANS: A, B, C, D

Anxiety, delirium, weakness, and grand mal seizures can be symptoms of rapid withdrawal from long-term use of benzodiazepine therapy. Severe pain is not a symptom of rapid withdrawal from long-term use of benzodiazepine therapy.

DIF: Cognitive Level: Knowledge REF: p. 198 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Patient Education | Safety 4. Which information will the nurse include when assessing the patient‘s central nervous system

(CNS) function following sedative-hypnotic therapy? (Select all that apply.) a. Level of alertness b. Orientation c. Ability to perform motor functions d. Blood pressure

e. Usual pattern of sleep ANS: A, B, C

Because sedative hypnotics depress overall CNS function, the nurse should identify the patient‘s level of alertness and orientation and ability to perform motor functions. Blood pressure is a vital sign and falls under cardiovascular assessment. Usual sleep pattern should be obtained for information on sleep pattern disruption but not for CNS function.

DIF: Cognitive Level: Application REF: p. 195 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Patient Education

Chapter 14: Drugs Used to Treat Neurodegenerative Disorders Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which adverse effects associated with levodopa therapy would support adding a nursing

diagnosis that relates to being at risk for injury to the patients plan of care? a. Nausea and vomiting b. Orthostatic hypotension c. Anorexia and depression d. Tachycardia and palpitations ANS: B

When initiating levodopa therapy, orthostatic hypotension may occur. Although generally mild, patients may experience dizziness and weakness. Symptoms usually resolve within 1 or 2 weeks once tolerance is developed to the levodopa therapy. Orthostatic hypotension increases the risk for injury in Parkinson‘s patients because they are also experiencing alterations in gait patterns. Although nausea, vomiting, anorexia, and depression are adverse effects of levodopa, they do not contribute to a risk for falling. Tachycardia and palpitations are not common adverse effects of levodopa.

DIF: Cognitive Level: Comprehension REF: p. 205 OBJ: 3 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Diagnosis CON: Clinical Judgment | Patient Education | Safety 2. Which vitamin will reduce the therapeutic effects of levodopa? a. A b. B6 c. C d. D ANS: B

Pyridoxine (vitamin B6) will reduce the therapeutic effects of levodopa in oral doses of 5 to 10 mg or more. Generally, diets typically have less than 1 mg of vitamin B6 and therefore are not restricted. The ingredients in multivitamins, however, must be assessed. Vitamins A, C, and D do not affect therapy with levodopa.

DIF: Cognitive Level: Comprehension REF: p. 208 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Patient Education

3. Which cholinergic symptoms of Parkinson‘s disease are reduced with anticholinergic drugs? a. Cognitive impairments b. Rigidity c. Tremors and drooling d. Postural abnormalities ANS: C

Anticholinergic drugs will reduce the severity of tremors and drooling in patients with Parkinson‘s disease. Anticholinergics are most useful when used in combination with levodopa. Anticholinergic drugs do not affect cognitive impairments. Anticholinergics have little effect on rigidity or on postural abnormalities.

DIF: Cognitive Level: Knowledge REF: p. 205 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Patient Education 4. Which pharmacologic action applies to entacapone? a. Slows the deterioration of dopaminergic nerve cells. b. Inhibits the relative excess of dopaminergic activity. c. Reduces the destruction of dopamine in peripheral tissues. d. Enhances the cholinergic symptoms of Parkinson‘s disease.

ANS: C

Entacapone, a COMT inhibitor, reduces dopamine destruction in peripheral tissues. This significantly increases the amount of dopamine available to reach the brain. Entacapone, when used with carbidopa levodopa therapy, results in more constant dopaminergic stimulation.

Entacapone is not effective when used alone. Entacapone does not affect the nerve cells but blocks enzymes that break down levodopa. Parkinson‘s disease is characterized by a relative deficit of dopaminergic activity. Entacapone does not affect cholinergic symptoms of Parkinson‘s disease.

DIF: Cognitive Level: Knowledge REF: p. 206 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Patient Education 5. Which statement by is accurate regarding the administration of levodopa? a. ―Take this medication in between meals.‖ b. ―Take this medication at bedtime to prevent dizziness.‖ c. ―Take this medication when your tremors get worse.‖ d. ―Take this medication with food or antacids to reduce GI upset.‖ ANS: D

Levodopa causes nausea, vomiting, and anorexia. Therefore, administration should be in divided doses with food or antacids to decrease gastrointestinal (GI) irritation. Levodopa should be taken with food. Levodopa must be taken on a regular schedule as prescribed to provide therapeutic results.

DIF: Cognitive Level: Comprehension REF: p. 212 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 3

6. Which adverse effects in patients with Parkinson‘s disease have been linked to dopamine

agonists? a. Oculogyric crisis b. Tardive dyskinesia c. Sudden sleep events d. Akathisia ANS: C

Sleep episodes have been reported with the dopamine agonists bromocriptine, pergolide, pramipexole, and ropinirole. These are described as ―sleep attacks,‖ including daytime sleep.

Oculogyric crisis is an adverse effect of neuroleptic drugs such as phenothiazines.

Tardive dyskinesia is a dystonic adverse effect of neuroleptic drugs such as phenothiazines.

Akathisia, associated with neuroleptic drugs used in the treatment of mental disorders, is characterized by motor restlessness accompanied by increased nervous or restless movement.

The syndrome may also occur when anti-Parkinson drugs are reduced or discontinued.

DIF: Cognitive Level: Comprehension REF: p. 217 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Patient Education | Safety 7. Which rationale applies to administering levodopa instead of dopamine for treatment of

Parkinson‘s disease? a. Dopamine does not cross the blood-brain barrier when administered orally. b. Levodopa is much less expensive. c. The half-life of dopamine is too short. d. Dopamine has too many reactions with other medications.

ANS: A

When administered orally, dopamine does not enter the brain. Levodopa does cross into the brain and is metabolized into dopamine. Dopamine is not available as an oral medication. The half-life of levodopa is approximately 50 minutes; the half-life of dopamine is approximately 4 days. Dopamine does not react with medications.

DIF: Cognitive Level: Comprehension REF: p. 211 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Patient Education | Health Promotion 8. Which statement by the patient recently placed on selegiline disintegrating tablets indicates a

need for further teaching? a. ―This medication will help slow the development of symptoms.‖ b. ―I will place the tablet on my tongue before breakfast.‖ c. ―I may need to use a stool softener for constipation.‖ d. ―I should not push the tablet through the foil.‖ ANS: B

Selegiline orally disintegrating tablets should be taken in the morning before breakfast, without liquid. This medication is used to slow the development of symptoms and progression of disease. Constipation is a common adverse effect that may require the use of stool softeners. Patients should not attempt to push selegiline orally disintegrating tablets through the foil backing. Patients should peel back the backing of one or two blisters (as prescribed) with dry hands and gently remove the tablet(s).

DIF: Cognitive Level: Comprehension REF: p. 210 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 4

9. Which statement about entacapone is correct? a. This medication is not to be taken with carbidopa levodopa. b. Dosage is adjusted according to the patient‘s response. c. There will be fewer incidences of dopaminergic effects, such as confusion. d. This medication increases the production of dopamine in the brain.

ANS: B

Dosage must be adjusted according to the patient‘s response and tolerance. Entacapone may be added to carbidopa levodopa therapy to prolong the activity of the dopamine by slowing its rate of metabolism. Entacapone may increase the adverse dopaminergic effects of levodopa.

Entacapone does not increase the production of dopamine in the brain.

DIF: Cognitive Level: Comprehension REF: p. 220 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 4

10. The nurse is assessing an older patient with Parkinson‘s disease who was started on

entacapone 1 week ago. The patient has a history of coronary artery disease and takes an antihypertensive and aspirin. Which information would support the need for a reduction in medication dosage by the healthcare provider? a. Constipation b. Brownish orange urine c. Drowsiness d. Dizziness ANS: D

Dizziness is a symptom of orthostatic hypotension; dosages may need to be altered.

Constipation is an expected adverse effect of this medication. Brownish orange urine is an expected adverse effect of this medication. Drowsiness is an expected adverse effect that occurs when therapy is initiated.

DIF: Cognitive Level: Application REF: p. 220 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Collaboration | Communication | Health Promotion | Safety 11. Which item should be removed from the meal try of a patient taking a monoamine oxidase B

inhibitor? a. Cheese

b. Eggs c. Bread d. Coffee ANS: A

Patients taking monoamine oxidase B inhibitors should avoid food and beverages with a high tyramine content, such as cheeses. Eggs, bread, and coffee do not have a high tyramine content.

DIF: Cognitive Level: Comprehension REF: p. 211 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety 12. Which medication should be held when a patient taking rasagiline is assessed by the nurse to

have a lasting significant increase in blood pressure? a. Dextromethorphan b. Levodopa c. Ciprofloxacin d. Valium ANS: C

Ciprofloxacin is an antibiotic that inhibits the metabolism of rasagiline, significantly raising rasagiline serum levels and potentially causing significant hypertension. Dextromethorphan, levodopa, and Valium are not related to significant hypertensive changes when used in conjunction with rasagiline.

DIF: Cognitive Level: Analysis REF: p. 211 OBJ: 4 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety MULTIPLE RESPONSE 1. Which characteristic symptom(s) apply(ies) to a patient‘s diagnosis of Parkinson‘s disease?

(Select all that apply.) a. Muscle tremors b. Posture alterations c. Muscle flaccidity d. Tachycardia e. Slow body movement ANS: A, B, E

Symptoms of Parkinson‘s disease include muscle tremors, posture and equilibrium alterations, and slow body movement or bradykinesia. Muscle flaccidity is not a symptom of Parkinson‘s disease. Symptoms of Parkinson‘s disease do not include alterations in heart rate.

DIF: Cognitive Level: Knowledge REF: p. 205 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment

2. Which point(s) should be included when teaching a patient about the use of apomorphine for

treatment of Parkinson‘s disease? (Select all that apply.) a. The restoration of function resulting from stimulation of dopamine receptors is permanent. b. Apomorphine may be administered intravenously for rapid relief. c. Apomorphine does not have any opioid activity. d. A multidose injector pen is commonly used to administer apomorphine. e. You may experience nausea and vomiting, which can be treated with trimethobenzamide (Tigan). f. You may experience sleep attacks or episodes of daytime sleepiness.

ANS: C, D, E, F

Apomorphine has no opioid activity, is commonly injected by a reusable multidose pen, and may cause nausea, vomiting, or sleepiness. Apomorphine brings temporary relief from hypomobility. Apomorphine must not be administered intravenously. It may crystallize in the vein and form a thrombus or embolism.

DIF: Cognitive Level: Comprehension REF: p. 214 | p. 215 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Patient Education 3. Which baseline assessment(s) will be performed prior to administering apomorphine to a

patient? (Select all that apply.) a. Mobility b. Orientation c. Intellectual ability d. Alertness e. Vital signs ANS: A, B, D, E

Premedication assessment prior to apomorphine therapy should include baseline vital signs, patient‘s degree of mobility, alertness, and orientation to name, place, and time. It is not necessary to assess intellectual ability prior to apomorphine therapy.

DIF: Cognitive Level: Application REF: p. 214 | p. 215 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety

Chapter 15: Drugs Used for Anxiety Disorders Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which time period is recommended for gradually tapering antianxiety medications before

discontinuation? a. 1 week b. 1 month c. 6 months d. 1 year ANS: B

Withdrawal from medication should be done under a healthcare provider‘s supervision.

Withdrawal usually takes 4 weeks and requires a gradual reduction in dosage and greater intervals between medication administrations. One week is an inadequate interval for cessation of antianxiety medication therapy. Six months to one year is much longer than necessary for cessation of antianxiety medication therapy.

DIF: Cognitive Level: Knowledge REF: p. 232 OBJ: 3 NAT: NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Patient Education | Safety 2. Which benzodiazepine is the choice when treating anxiety associated with alcohol

withdrawal? a. Chlordiazepoxide (Librium) b. Oxazepam (Serax) c. Diazepam (Valium) d. Clorazepate (Tranxene) ANS: B

Oxazepam and lorazepam are the drugs of choice in treating anxiety disorders because they have no active metabolites. Chlordiazepoxide and clorazepate are not the drugs of choice when treating anxiety associated with alcohol withdrawal. Diazepam has not been studied as fully as oxazepam in treating patients who have hepatic function impairment.

DIF: Cognitive Level: Knowledge REF: p. 232 OBJ: 3 NAT: NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Patient Education 3. Which drug of choice is used to treat a patient with obsessive-compulsive disorder (OCD)? a. Lorazepam (Ativan) b. Buspirone (BuSpar) c. Fluvoxamine (Luvox) d. Hydroxyzine (Vistaril) ANS: C

Fluvoxamine inhibits the reuptake of serotonin at the nerve endings, thus prolonging serotonin activity. Fluvoxamine is used for the treatment of OCD when the obsessions or compulsions cause marked distress or interfere substantially with social or occupational responsibilities.

Fluvoxamine does not prevent the obsessions or compulsions; the therapeutic outcome of this drug is to assist the patient in his or her management. Lorazepam, buspirone, and hydroxyzine do not treat the symptoms of OCD. DIF: Cognitive Level: Knowledge REF: p. 230 OBJ: 3 NAT: NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Patient Education 4. The outcome statement for a patient suffering from anxiety disorder reads, ―After 1 week on

alprazolam (Xanax) therapy, patient will exhibit a manageable level of anxiety.‖ Which assessment finding validates that this outcome is met? a. Patient is unable to participate in group therapy conversations. b. Patient reports persistent fear about dying of a rare illness. c. Patient verifies that family reunions trigger anxiety and excessive drinking.

d. Patient reports sleeping better and increased interest in activities.

ANS: D

The primary therapeutic outcome expected from benzodiazepine antianxiety agents is a decrease in the level of anxiety to a manageable level. Physical signs of anxiety have decreased, and coping is improved. Being unable to participate in group therapy, persistent fears, and choosing inappropriate coping mechanisms for noncatastrophic events indicate that the anxiety is not manageable.

DIF: Cognitive Level: Application REF: p. 230 OBJ: 3 NAT: NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Patient Education 5. Which statement is true regarding psychological drug dependence? a. It is easier to treat than physiologic dependence. b. It is not considered a true addiction. c. It is easily controlled by influencing the patient‘s perceptions. d. It requires medical intervention to treat.

ANS: D

Medical intervention is required to treat psychological drug dependence. Psychological addictions are often more difficult to overcome than physiologic addictions. Psychological drug dependence can be very difficult to treat.

DIF: Cognitive Level: Comprehension REF: p. 234 OBJ: 5 NAT: NCLEX Client Needs Category: Psychological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Patient Education 6. Which pertinent information should be included in a teaching plan about antianxiety

medications? a. Discuss, review, and validate the behavior monitoring system and intervention flow sheet the patient and significant other will continue to use following discharge. b. Discuss the possible dependence associated with the medication at length to make sure the patient does not overuse the drug. c. Instruct the patient to educate family members about the medication therapy, based on recollection of discussions with the nurse. d. Provide all instructions verbally, with repetition as needed when requested by the patient.

ANS: A

It is the responsibility of the nurse to educate patients about their therapy, monitoring for therapeutic benefit and adverse effects to expect and report, and intervening whenever possible to optimize therapeutic outcomes. Making the patient fearful of the medication therapy defeats the purpose of using the drug to control anxiety. The topic should be mentioned because it is important, but it should not be emphasized. Family members or significant others should participate in discussions with the nurse whenever possible, and the patient should be given written instructions to refer to after discharge. Verbal instruction should be backed up with written documents for the patient to refer to after discharge.

DIF: Cognitive Level: Comprehension REF: p. 231 | p. 232 OBJ: 3 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment

TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education 7. Which information is necessary to provide to a patient prescribed an azapirone antidepressant? a. Risk for addiction b. Adverse effect of nausea c. Risk of injury when using machinery d. Additive effects of central nervous system (CNS) depression with alcohol ANS: C

The most common adverse effects of azapirone therapy include dizziness, nervousness, drowsiness, and lightheadedness. Azapirones do not have a risk for abuse or addiction.

Nausea and vomiting are not common adverse effects of treatment with azapirones.

Azapirones do not have CNS depression, but it is recommended that they not be combined with alcohol or sedatives.

DIF: Cognitive Level: Comprehension REF: p. 234 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety

OBJ: 4

8. Which patient is most likely to respond quickly to antianxiety therapy with benzodiazepines? a. Patient with a history of long-term anxiety b. Patient with recent anxiety reactions c. Patient with severe depression in addition to being anxious d. Patient with incidents of auditory hallucinations ANS: B

Patients with anxiety reactions to recent events and those with a treatable medical illness that induces anxiety respond most readily to benzodiazepine therapy. Long-term anxiety is best treated with medications other than benzodiazepines (e.g., prescription medications such as Zoloft, Paxil, Prozac, Effexor, and Wellbutrin). Severe depression does not improve with treatment of benzodiazepines. Patients who are having psychotic symptoms do not respond to benzodiazepines.

DIF: Cognitive Level: Comprehension REF: p. 232 OBJ: 1 | 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment 9. What instruction is most important for the nurse to teach the patient who has recently been

prescribed alprazolam (Xanax)? a. ―The medication needs to be taken on an empty stomach.‖ b. ―You may feel dizzy or unsteady when rising to a standing position.‖ c. ―Smoking will require a reduction in dosage of the medication.‖ d. ―Over-the-counter medications are safe to take while on this medication.‖ ANS: B

Patients may experience a transient episode of hypotension on arising. This medication does not need to be taken on an empty stomach. Smoking enhances the metabolism of benzodiazepines; larger doses may be necessary to maintain effects. Over-the-counter medications are to be approved by the healthcare provider. Antihistamines, for example, increase toxic effects.

DIF: Cognitive Level: Comprehension REF: p. 233 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 4

10. Which information should be included in a teaching plan about buspirone (BuSpar)? a. There is minimal potential for abuse. b. Signs of improvement can be seen within 3 days. c. Sedation is increased compared with other antianxiety medications. d. It stimulates the action of gamma-aminobutyric acid (GABA).

ANS: A

There is minimal potential for abuse with buspirone. It takes longer than 3 days to see signs of improvement. Buspirone has lower sedative properties and does not affect GABA receptors.

DIF: Cognitive Level: Comprehension REF: p. 234 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 3

11. Which priority nursing applies when a newly admitted psychiatric patient repetitively states,

―I wish I were dead. I just want to kill myself.‖? a. Establish a trusting relationship. b. Encourage a nonstimulating environment. c. Provide for patient safety. d. Identify signs of increased anxiety.

ANS: C

If the patient has suicidal ideas, intervention to provide patient safety is the priority nursing action. Although establishing a trusting relationship should occur, safety is the nursing priority. Once safety is established, support and reassurance may be provided. A nonstimulating environment should be encouraged once safety is established. Once patient safety is established signs of increased anxiety can be identified.

DIF: Cognitive Level: Application REF: p. 231 NAT: NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Implementation

OBJ: 2 CON: Clinical Judgment | Safety

12. Which route is the most appropriate route of administration for lorazepam with a patient

experiencing nausea and vomiting as a result of alcohol withdrawal? a. By mouth b. Rectally c. Intramuscularly d. Subcutaneously ANS: C

The use of lorazepam is somewhat limited for use with symptoms of alcohol withdrawal for those who cannot tolerate oral administration because of nausea and vomiting. The most appropriate route in this situation would be intramuscularly.

DIF: Cognitive Level: Application

REF: p. 231

OBJ: 3

NAT: NCLEX Client Needs Category: Safe, Effective Care Environment | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Patient Education MULTIPLE RESPONSE 1. A patient is admitted to the adult psychiatric floor with a diagnosis of generalized anxiety

disorder. Anxiolytic medications and group therapy have been prescribed. Which assessment(s) will measure evaluation of therapeutic outcomes related to this patient‘s acute stay? (Select all that apply.) a. Patient is able to sleep 5 hours during the night. b. The tremor and pacing exhibited on admission are reduced. c. Patient is able to attend and actively participate in group sessions. d. Patient is eating only 10% of her meals. e. Patient complains of chest pain before group therapy.

ANS: A, B, C

A primary therapeutic outcome expected from antianxiety therapy agents is a decreased level of anxiety to a manageable level with the ability to get adequate rest and nourishment, a decrease or elimination of somatic complaints, and active and appropriate participation in group therapy. Improved appetite would be a sign of decreased anxiety. Chest pain may be an example of somatization, especially when experienced during emotionally stressful times, such as group therapy.

DIF: Cognitive Level: Application REF: p. 229 | p. 230 | p. 231 OBJ: 3 NAT: NCLEX Client Needs Category: Psychological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment 2. Which substance(s) may increase the toxic effects of benzodiazepines? (Select all that apply.) a. Alcohol b. Antihistamines c. Analgesics d. Sedatives e. Vitamins f. Hypnotics ANS: A, B, C, D, F

Alcohol, antihistamines, analgesics, sedatives, and hypnotics may cause excessive sedation and impaired psychomotor function when taken concurrently with benzodiazepines. Vitamins do not cause excessive sedation and impaired psychomotor function when taken concurrently with benzodiazepines.

DIF: Cognitive Level: Knowledge REF: p. 234 OBJ: 4 NAT: NCLEX Client Needs Category: Psychological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Patient Education | Safety 3. Which therapeutic outcome(s), in addition to the relief of mild to moderate anxiety, apply(ies)

to hydroxyzine (Vistaril)? (Select all that apply.) a. Reduced need for sedation and analgesia before and after surgery b. Elimination of psychotic thinking c. Control of itching in allergic reactions

d. Control of vomiting e. Control of obsessive-compulsive thoughts f. Prevention of extrapyramidal adverse effects and tardive dyskinesia ANS: A, C, D

Hydroxyzine has sedative, antihistamine, and antiemetic effects in addition to antianxiety activity. Hydroxyzine does not control psychotic thinking, obsessive-compulsive thinking, or movement disorders caused by other medications.

DIF: Cognitive Level: Comprehension REF: p. 229 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Patient Education 4. Which assessment(s) would be included in the evaluation of a patient with anxiety? (Select all

that apply.) a. Physical examination b. Psychological evaluation c. History of precipitation stressors d. Medication history e. Substance abuse history f. Blood glucose level ANS: A, B, C, D, E

Physical examination, psychological evaluation, history of precipitation stressors, medication history, and substance abuse history are important in evaluating a patient with anxiety to get a complete background on the patient. The blood glucose level is not included in evaluation of a patient with anxiety.

DIF: Cognitive Level: Comprehension REF: p. 230 OBJ: 2 NAT: NCLEX Client Needs Category: Psychological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 5. The prenatal nurse is educating a woman regarding preconception care. The patient informs

the nurse that she is currently taking a benzodiazepine drug for management of anxiety.

Which information is appropriate to include when providing patient education? (Select all that apply.) a. Readily cross into breast milk. b. Are safe to take throughout pregnancy. c. Enter fetal circulation. d. Are not associated with ill effects on the infant following birth. e. May increase newborn muscle tone.

ANS: A, C

It is recommended that benzodiazepines not be administered during at least the first trimester of pregnancy. There may be an increased incidence of birth defects because these agents readily cross the placenta and enter fetal circulation. Mothers who are breastfeeding should not receive benzodiazepines regularly. The benzodiazepines readily cross into breast milk and exert a pharmacologic effect on the infant. If benzodiazepines are taken regularly during pregnancy, the infant should be monitored closely after delivery for signs of withdrawal, including hypotonia.

DIF: Cognitive Level: Comprehension

REF: p. 233

OBJ: 4

NAT: NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Development

Chapter 16: Drugs Used for Depressive and Bipolar Disorders Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which symptom occurs with mania associated with bipolar disorder? a. Varying degrees of sadness b. Distinct episodes of elation c. Suicide d. Psychomotor retardation ANS: B

Mania is characterized by distinct episodes of euphoria and elation. Sadness is characteristic of depression. Suicide is not generally associated with mania; it is more commonly associated with depression. Psychomotor retardation is not associated with mania.

DIF: Cognitive Level: Comprehension REF: p. 239 | p. 240 OBJ: 1 NAT: NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Mood and Affect 2. Which postoperative narcotic analgesic will most likely be prescribed to a patient whose

current medications include a monoamine oxidase inhibitor (MAOI), a thyroid hormone, and a multivitamin? a. Meperidine (Demerol) b. Morphine c. Ibuprofen (Advil) d. Acetaminophen (Tylenol) ANS: B

Morphine is the narcotic analgesic of choice because it will not interact with the patient‘s MAOI. Meperidine will interact with the patient‘s medication. Ibuprofen and acetaminophen are not narcotic analgesics.

DIF: Cognitive Level: Comprehension REF: p. 249 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 3. Which major advantage exists with use of selective serotonin reuptake inhibitors (SSRIs) over

other types of antidepressant therapy? a. They are less expensive than the other classes of antidepressants. b. They cure major depressive illnesses. c. They do not cause the anticholinergic and cardiovascular adverse effects. d. Therapeutic relief is immediate.

ANS: C

SSRIs are the most widely used class of antidepressants. Although they are as effective in treating depression as the tricyclic antidepressants, they do not cause the anticholinergic and cardiovascular adverse effects that often limit the use of tricyclic antidepressants. SSRIs tend to be more expensive than other available antidepressants. SSRIs do not cure major depressive illnesses. As with other antidepressants, it takes 2 to 4 weeks to obtain the full therapeutic benefit when taking SSRIs. DIF: Cognitive Level: Knowledge REF: p. 249 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Safety 4. Which disorder diagnosed in a patient would the nurse expect the drug of choice to be lithium

(Eskalith)? a. Psychotic episodes b. Obsessive-compulsive disorders (OCDs) c. Bipolar disorders d. Depressive disorders ANS: C

Lithium is used to treat acute mania and for prophylactic treatment of recurrent manic and depressive episodes in bipolar disorders. Psychotic episodes are treated with major tranquilizers that have an antipsychotic effect. The drugs of choice for treating OCD are SSRIs. Depressive disorders are not primarily treated with lithium.

DIF: Cognitive Level: Comprehension REF: p. 258 OBJ: 1 | 7 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 5. Which psychological manifestation of depression will improve in response to antidepressant

therapy? a. Loss of energy b. Palpitations c. Sleep disturbances d. Social withdrawal ANS: D

Social withdrawal and lack of interest in surroundings are psychological responses that will improve within 2 to 4 weeks of the patient receiving an effective dosage of antidepressant therapy. An increase in energy, decreased palpitations, and improvement in sleep patterns are physiologic responses.

DIF: Cognitive Level: Comprehension REF: p. 242 NAT: NCLEX Client Needs Category: Psychological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Mood and Affect

OBJ: 1

6. Which rationale explains the basis of choosing to prescribe tricyclic antidepressants for

treatment? a. The need to decrease the action of norepinephrine, dopamine, or serotonin b. Patient age and gender c. An absence of adverse effects, such as orthostatic hypotension

d. The need for stimulation and increased mental alertness ANS: B

The choice of tricyclic antidepressants is based on their individual therapeutic characteristics.

Tricyclics prolong the action of norepinephrine, dopamine, and serotonin. All tricyclics produce orthostatic hypotension to some degree. All tricyclics produce sedation, not stimulation.

DIF: Cognitive Level: Comprehension REF: p. 247 | p. 248 OBJ: 2 NAT: NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 7. The nurse is teaching a patient about medication treatment for depression. The patient asks

how long it will take before sleep and appetite will begin to improve. Which response by the nurse is most accurate? a. 3 days b. 1 week c. 4 weeks d. 2 months ANS: B

The physiologic manifestations of depression (sleep disturbance, change in appetite, loss of energy, fatigue, palpitations) begin to be alleviated within the first week of therapy. It takes longer than 3 days for the symptoms to improve. Four weeks and two months are longer than it takes for the symptoms to improve.

DIF: Cognitive Level: Comprehension REF: p. 244 | p. 245 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education 8. Which action applies to MAOIs on neurotransmitters? a. Blocking their reuptake b. Increasing their production c. Blocking their destruction d. Increasing their reuptake ANS: C

MAOIs act by blocking the metabolic destruction of epinephrine, norepinephrine, dopamine, and serotonin neurotransmitters by the enzyme monoamine oxidase in the presynaptic neurons of the brain. They prevent the degradation of these central nervous system (CNS) neurotransmitters so that their concentration is increased. MAOIs do not block or increase the reuptake of neurotransmitters. MAOIs do not increase production of neurotransmitters.

DIF: Cognitive Level: Comprehension REF: p. 245 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 3 CON: Clinical Judgment

9. A patient who is taking an MAOI to treat depression admits to eating pickled herring and

cheese and drinking red wine. Which assessment finding alerts the nurse to a potential complication? a. Constipation

b. Hypotension c. Neck stiffness d. Urinary retention ANS: C

Hypertensive crisis is a major potential complication. Common prodromal symptoms of hypertensive crisis include severe occipital headache, stiff neck, sweating, nausea, vomiting, and sharply elevated blood pressure. Constipation, hypotension, and urinary retention are not indicative of a major potential complication when patients consume foods high in tyramine.

DIF: Cognitive Level: Application REF: p. 245 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 10. Which assessment would the nurse expect to observe in a patient who has been prescribed

trazodone for treatment anxiety? a. Excessive thirst b. Hand tremor c. Drowsiness d. Diarrhea ANS: C

Drowsiness is a common adverse effect, and people who work with machinery, drive a car, administer medicines, or perform other duties in which they must remain mentally alert should not take trazodone while working. Excessive thirst, hand tremors, and diarrhea are not adverse effects associated with trazodone.

DIF: Cognitive Level: Comprehension REF: p. 255 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 11. The nurse is caring for a patient who is taking a newly prescribed drug, nefazodone, for

treatment of depression. Which physical assessment finding is most important for the nurse to report to the healthcare provider immediately? a. Bradycardia b. Dizziness c. Drowsiness d. Urinary retention ANS: A

Bradycardia with a drop in 15 beats/min is to be reported to the healthcare provider immediately; withholding the dose is warranted until approved. Dizziness, drowsiness, and urinary retention are common adverse effects that would not need to be reported to the healthcare provider.

DIF: Cognitive Level: Comprehension REF: p. 255 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 12. Which statement by the patient would indicate the need for further teaching after being

educated on bupropion (Wellbutrin) prescribed for smoking cessation? a. ―My dose will increase after 3 days.‖

b. ―I should swallow this medication whole.‖ c. ―If I have the urge to smoke, I will take more medication.‖ d. ―I do not need to taper my dose when the drug is discontinued.‖ ANS: C

Dosage will begin at 150 mg/day for the first 3 days and then, for most patients, be increased to 300 mg/day. The patient is maintained on doses of 300 mg/day for 7 to 12 weeks and dosage is not based on a desire to smoke. Bupropion should be swallowed whole, not crushed, divided, or chewed. Dose tapering is not required when discontinuing bupropion.

DIF: Cognitive Level: Application REF: p. 253 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Patient Education 13. Which nursing action is most important when providing care to a patient diagnosed with a

mood disorder? a. Assess the patient for thoughts of suicide. b. Provide supplemental feedings as needed. c. Assist with activities of daily living. d. Offer opportunities for interaction with other patients.

ANS: A

Determining if there is a risk for suicide, monitoring at specified intervals, and providing patient safety and supervision are the highest priorities with severe mood disorders. Providing supplemental feedings, assisting with activities of daily living, and offering opportunities for interaction with other patients are not priorities of care.

DIF: Cognitive Level: Application REF: p. 243 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Intervention CON: Clinical Judgment | Safety | Mood and Affect 14. A patient is admitted to a long-term psychiatric setting. The MAOI medication previously

prescribed is discontinued by the physician. New orders are obtained to initiate imipramine therapy. Which time applies to when the nurse will provide the first dose of imipramine to the patient? a. Immediately following the last dose of b. In 1 week following the last dose of c. In 14 days following the last dose of d. Before discontinuing ANS: C

MAOIs and TCAs, especially imipramine and desipramine, should not be administered concurrently. It is recommended that at least 14 days lapse between discontinuing an MAOI and starting SSRI/SNRI therapy.

DIF: Cognitive Level: Analysis REF: p. 245 OBJ: 3 | 6 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment 15. Which concern is the priority when a patient taking vilazodone has been vomiting persistently

for 12 hours?

a. b. c. d.

Nausea Poor nutrition Dehydration Issues with peripheral tissue perfusion

ANS: C

Nausea and vomiting are common adverse effects of vilazodone. Persistent vomiting should be evaluated for other causes, as well as for the development of electrolyte imbalance.

Dehydration can lead to life-threatening cardiac arrhythmias and therefore is the priority nursing concern. The concern of nausea is appropriate but is not the priority. Poor nutrition is an appropriate concern but is not the priority at this time. Issues with peripheral tissue perfusion does not apply to this scenario.

DIF: Cognitive Level: Analysis REF: p. 249 | p. 256 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Diagnosis CON: Clinical Judgment | Fluid and Electrolytes | Safety MULTIPLE RESPONSE 1. Which area(s) should be addressed by the nurse when obtaining a history of a patient admitted

with depression? (Select all that apply.) a. Current medications and medical history b. Recent stressors and support system c. Family history of mood disorder d. Dietary patterns e. Insurance coverage ANS: A, B, C, D

It is important to obtain a thorough history when assessing the patient with depression, including current medical status and medications, recent stressors, support system, family history of mood disorders, and nutritional patterns. Financial matters should not be part of the nursing assessment.

DIF: Cognitive Level: Application REF: p. 239 | p. 242 | p. 243 | p. 244 OBJ: 1 NAT: NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 2. Which instruction(s) is/are most pertinent to include in the discharge teaching of a patient on

lithium (Eskalith) who is being discharged? (Select all that apply.) a. ―Persistent vomiting and profuse diarrhea are signs of toxicity and must be reported to the healthcare provider immediately.‖ b. ―It is important to comply with schedules for blood tests to assess therapeutic levels.‖ c. ―You should avoid foods such as Chianti wine and aged cheeses.‖ d. ―The common adverse effects to expect, which are excessive nausea, anorexia, and abdominal cramps, tend to resolve.‖ e. ―You will be gradually weaned off this medication.‖ f. ―Take the medication with food or milk.‖ ANS: A, B, D, F

Patients should be informed of the importance of toxic symptoms to report and monitoring therapeutic lithium levels. Nausea, vomiting, and abdominal cramps are common adverse effects and tend to resolve. Lithium should be administered with food or milk. Chianti wine and aged cheeses are to be avoided during MAOI therapy. The bipolar patient may be on lithium treatment for the rest of his or her life and will not be weaned from the medication.

DIF: Cognitive Level: Application REF: p. 258 | p. 259 OBJ: 7 NAT: NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education 3. Which information will the nurse include in a teaching plan for a patient with depression

being treated with amitriptyline (Elavil)? (Select all that apply.) a. Dryness of the mouth is normal; sucking on sugar free hard candy and ice chips or chewing gum may help alleviate this problem. b. Rise slowly from a supine or sitting position to avoid dizziness and orthostatic hypotension. c. Avoid alcohol and barbiturates. d. If adverse effects occur, discontinue the medication. e. An immediate elevation in mood will be noted.

ANS: A, B, C

Common adverse effects associated with tricyclic antidepressants are dry mouth and orthostatic hypotension. Alcohol and barbiturates should be avoided while taking tricyclic antidepressants because they enhance sedation. Adverse effects are likely to occur, and the medication should not be discontinued without the direction of the healthcare provider.

Tricyclic antidepressants typically take several weeks to produce a therapeutic effect.

DIF: Cognitive Level: Application REF: p. 250 | p. 251 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education 4. Which food(s) containing significant amounts of tyramine will be contraindicated when a

patient is on MAOI therapy? (Select all that apply.) a. Beer b. Red meat c. Aged cheeses d. Green vegetables e. Bananas ANS: A, C, E

Beer, red wines, well-ripened cheeses (such as camembert, edam, roquefort, parmesan, mozzarella, and cheddar), and overripe bananas contain tyramine. Red meat and green vegetables do not contain tyramine.

DIF: Cognitive Level: Knowledge REF: p. 245 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Patient Education | Health Promotion | Safety

5. Which nursing assessment(s) is/are important before the initiation of antidepressant therapy?

(Select all that apply.) a. Compliance with medication therapy within the last 2 months b. Nonverbal interactions among patient and significant others present c. Evaluation of the coherency, relevancy, and organization of thoughts in responses d. Appearance and posture e. Elimination pattern ANS: A, B, C, D

Compliancy with prescribed medications over the last 2 months provides the healthcare provider with information regarding the patient‘s state of mind and ability to follow through with medication administration independently. Patients with altered thought processes often display inconsistencies between statements of feelings and behavior norms in social settings.

Coherency, relevancy, and organization of thoughts are often affected by thought disorders.

This assessment also provides information regarding the accuracy of other information that the patient has offered. Note general appearance and appropriateness of attire and posture because these are often affected by mood disorders. Elimination pattern is not a priority premedication assessment.

DIF: Cognitive Level: Application REF: p. 242 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 6. Which statement(s) is/are true regarding the pharmacologic actions of certain antidepressant

drugs? (Select all that apply.) a. MAOIs block the effects of dopamine in the CNS. b. SSRIs inhibit the destruction and reuptake of serotonin at the synaptic cleft. c. Tricyclic antidepressants block the action of norepinephrine and epinephrine in the SNS. d. Monocyclic antidepressants such as bupropion (Wellbutrin) have an unknown mechanism of action. e. SNRIs prolong the action of neurotransmitters by decreasing the destruction of serotonin and norepinephrine.

ANS: B, D, E

SSRIs block the destruction and storage of serotonin at the synaptic cleft, therefore increasing the amount of serotonin available. Monocyclic antidepressants have an unknown mechanism of action. They are weaker inhibitors of the reuptake and inactivation of the neurotransmitters serotonin norepinephrine and dopamine. SNRIs act by inhibiting the reuptake and destruction of serotonin and norepinephrine and, to a lesser extent, dopamine, from the synaptic cleft, thereby prolonging the action of the neurotransmitters. MAOIs act by blocking the metabolic destruction of dopamine, so concentration is increased. Tricyclics block the reuptake of neurotransmitters, not their effects.

DIF: Cognitive Level: Comprehension REF: p. 245 | p. 248 | p. 249 OBJ: 3 | 4 | 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment 7. Which drug(s) interact(s) with SSRI agents? (Select all that apply.) a. Tranylcypromine (Parnate) b. Lithium (Eskalith)

c. Warfarin (Coumadin) d. Furosemide (Lasix) e. Propranolol (Inderal) ANS: A, B, C, E

A 14-day lapse is recommended between MAOIs, such as Parnate, and SSRI agents.

The incidence of lithium toxicity is increased with SSRI agents. The anticoagulant effects of warfarin may be enhanced with SSRIs. The SSRIs fluvoxamine and citalopram inhibit the metabolism of beta-adrenergic blocking agents such as propranolol. Lasix does not interact with SSRI agents.

DIF: Cognitive Level: Knowledge REF: p. 249 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 4 CON: Clinical Judgment | Safety

8. Which potential adverse effect(s) apply to the use of tricyclic antidepressants? (Select all that

apply.) a. Diarrhea b. Dryness of mouth, nose, and throat c. Constipation d. Nocturia e. Urinary retention f. Blurred vision ANS: B, C, E, F

The patient may experience difficulty with dryness of the mouth, nose, and throat as well as smooth muscle contraction (resulting in constipation, urinary retention, and blurred vision).

Diarrhea and nocturia are not adverse effects of tricyclic antidepressants.

DIF: Cognitive Level: Knowledge REF: p. 250 | p. 251 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 9. The nurse is preparing 0800 medications for a patient with the medical diagnosis of end-stage

renal disease. When reviewing the medication administration record (MAR), the nurse notices the patient is scheduled to receive an MAOI drug. Which intervention(s) will the nurse perform before administering the drug? (Select all that apply.) a. Assess temperature. b. Provide an alternative drug. c. Hold the MAOI drug. d. Consult with the prescribing healthcare provider. e. Assess urine output prior to administration.

ANS: C, D

If the patient prescribed an MAOI drug has a history of severe renal disease, the medication must not be given and the prescribing healthcare provider consulted. It is not necessary to assess temperature at this time. An alternative medication needs to be ordered by a healthcare provider licensed to prescribe. Assessing urine output does not apply to this situation.

DIF: Cognitive Level: Application REF: p. 245 | p. 248 OBJ: 2 | 3 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment | NCLEX Client Needs

Category: Physiological Integrity CON: Clinical Judgment | Safety

TOP: Nursing Process Step: Implementation

Chapter 17: Drugs Used for Psychoses Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which term applies to what a patient is experiencing when reporting they are hearing voices? a. Delusions b. Flight of ideas c. Disorganized thinking d. Hallucinations ANS: D

Hallucinations are false sensory perceptions that are experienced without an external stimulus but seem real to the patient. Auditory hallucinations are prominent in a schizophrenic patient.

Additional sensory hallucinations include those of touch, sight, smell, and body sensation.

Delusions are false beliefs that persist despite evidence to the contrary. Flight of ideas is characterized by rapid changes in thought from one topic to another. Disorganized thinking is commonly associated with psychoses and consists of a flight of ideas during which the individual jumps from one idea or topic to another one.

DIF: Cognitive Level: Knowledge REF: p. 263 OBJ: 1 NAT: NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Psychosis | Sensory Perception 2. A patient with schizophrenia has been nonadherent with his home medication regimen and

requires frequent admissions to the intensive psychiatric unit for treatment of acute psychotic episodes. Which medication regimen would be appropriate for this patient? a. Daily home nursing visits to administer the prescribed oral medication b. Continuous inpatient hospitalization for medication therapy c. Administration of depot antipsychotic medication d. Subcutaneous medication administration ANS: C

Depot antipsychotic medications are long-acting injections that may be used with noncompliant patients and may assist in avoiding repeated hospital admissions. Daily home nursing visits are not an efficient way to ensure medication compliance. Continuous inpatient hospitalization is not an efficient way to ensure medication compliance. Subcutaneous medication administration is not an option for this patient.

DIF: Cognitive Level: Application REF: p. 269 OBJ: 2 | 3 NAT: NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Psychosis | Adherence Behavior | Sensory Perception 3. Which cause is the most common reason for nonadherence to antipsychotic pharmacologic

treatment? a. Expense b. Increased symptoms of chemical dependency

c. Extrapyramidal effects d. Inability of the patient to understand the need to take medications ANS: C

Extrapyramidal effects are the most common reason for nonadherence to antipsychotic therapy. The four categories of extrapyramidal effects are dystonic reactions, pseudoparkinsonism, akathisia, and tardive dyskinesia. Although expense may be a concern, it is not the most common reason for noncompliance. Chemical dependency is not a feature of therapy with antipsychotic drugs. Although knowledge deficit is a concern, it is not the most common reason for noncompliance.

DIF: Cognitive Level: Comprehension REF: p. 268 | p. 272 OBJ: 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Adherence Behavior 4. Which type of adverse effects is present when a patient displays prolonged tonic contractions

of the tongue, oculogyric crisis, and torticollis? a. Dystonic reactions b. Pseudoparkinsonism c. Akathisia d. Tardive dyskinesia ANS: A

Dystonic reactions are the first extrapyramidal symptoms to occur when a patient is taking antipsychotic agents. Dystonias are spasmodic movements of muscle groups such as tongue protrusion, rolling back of the eyes (oculogyric crisis), jaw spasms (trismus), or neck torsion (torticollis). Pseudoparkinsonism is characterized by tremor and rigidity. Akathisia is characterized by subjective feelings of anxiety and restlessness, accompanied by pacing and the inability to remain in one place for extended periods. Tardive dyskinesia is characterized by persistent involuntary hyperkinetic movements.

DIF: Cognitive Level: Comprehension REF: p. 268 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 5. Which potential complication of clozapine (Clozaril) requires weekly blood tests for the first 6

months of treatment? a. Agranulocytosis b. Vitamin deficiencies c. Clotting abnormalities d. Polycythemia ANS: A

The use of clozapine requires a baseline and weekly white blood cell (WBC) counts because of the high incidence of agranulocytosis. Clozapine does not cause vitamin deficiencies.

Clozapine does not interfere with clotting abilities. Clozapine does not affect red blood cell volume.

DIF: Cognitive Level: Knowledge REF: p. 273 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Patient Education | Safety | Health Promotion

6. Which action will the nurse take when a patient becomes verbally aggressive and insists the

nurse is poisoning him as she attempts to administer haloperidol (Haldol)? a. Support the patient‘s decision to refuse the medication. b. Discreetly ask an assistant to put the medication in the patient‘s food. c. Firmly redirect the patient to take the medication. d. Speak privately with the patient and reinforce medication action.

ANS: C

During episodes of acute psychosis, the patient is out of touch with reality and often does not understand the need for medication in stabilizing his or her condition. Target symptoms such as agitation, suspicion, and paranoia are common. Healthcare providers must be supportive yet firm in their expectations. An open and direct manner in handling patients who are highly suspicious is critical. Delusions should not be supported. The patient is not competent to determine his need for medication. It is dishonest to hide medication in a patient‘s food and destroys a trusting relationship. Reasoning with the patient is unlikely to change his mind; he needs external structure for making decisions when he is aggressive and paranoid.

DIF: Cognitive Level: Application REF: p. 271 | p. 272 OBJ: 1 NAT: NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Psychosis | Safety 7. Which statement is true regarding the adverse effects associated with antipsychotic

medications? a. Tardive dyskinesia is a common, reversible condition. b. Painful dystonic reactions can occur in the first 72 hours of initiation of therapy. c. Neuroleptic malignant syndrome (NMS) is a common adverse effect. d. Pseudoparkinsonian symptoms can cause Parkinson‘s disease.

ANS: B

Approximately 90% of all dystonic reactions occur in the first 72 hours of antipsychotic therapy. These symptoms are often frightening and painful. Tardive dyskinesia is present in 20% to 25% of patients and may become irreversible. NMS is not a common adverse effect.

Pseudoparkinsonism is not related to Parkinson‘s disease.

DIF: Cognitive Level: Comprehension REF: p. 268 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment 8. Which rationale explains the meaning of potency of an antipsychotic medication? a. Severity of adverse effects associated with the drug b. Length of time that it takes to reach a therapeutic blood level of the drug c. Milligram doses used for the medication d. Effectiveness of the drug in alleviating psychotic behavior ANS: C

Low and high potency refers only to the milligram doses used for the medications and does not suggest any difference in effectiveness. Potency is not related to severity of adverse effects or onset of action. Potency does not refer to effectiveness.

DIF: Cognitive Level: Comprehension

REF: p. 263

OBJ: 3

NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

CON: Clinical Judgment

9. Which term refers to dystonic reactions, pseudoparkinsonism, akathisia, and tardive

dyskinesia? a. Extrapyramidal symptoms b. Allergic reactions c. Idiosyncratic reactions d. Therapeutic responses ANS: A

There are four categories of extrapyramidal symptoms: dystonic reactions, pseudoparkinsonism, akathisia, and tardive dyskinesia. These are not allergic reactions, idiosyncratic reactions, or therapeutic responses.

DIF: Cognitive Level: Knowledge REF: p. 264 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment 10. Which nursing intervention is appropriate for a patient who has recently been prescribed

clozapine (Clozaril)? a. Assess for signs and symptoms of hypoglycemia. b. Encourage a low-fiber diet. c. Measure the patient‘s waist circumference. d. Monitor for insomnia.

ANS: C

Waist circumference baseline measurement is appropriate because of the weight gain and onset of diabetes with use of these medications. Hypoglycemia and insomnia do not occur with this medication. A low-fiber diet is not appropriate.

DIF: Cognitive Level: Application REF: p. 272 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment 11. Which medication should be prepared when a patient taking an antipsychotic is experiencing

an oculogyric crisis? a. Diphenhydramine b. Haloperidol c. Aripiprazole d. Risperidone ANS: A

Acute dystonic reactions may be controlled by intramuscular injections of diphenhydramine.

Haloperidol, aripiprazole, and risperidone are not used for dystonic reactions.

DIF: Cognitive Level: Application REF: p. 268 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation MULTIPLE RESPONSE

OBJ: 4 CON: Clinical Judgment | Safety

1. Which sign(s) and/or symptom(s) would support the diagnosis of psychosis? (Select all that

apply.) a. Constant eye contact during the admission history b. Deterioration of social functioning c. Reporting that the FBI has solicited important secret information from his phone conversations d. Confirmation of hearing voices in his head e. Changing the topic of conversation inappropriately ANS: B, C, D, E

Social deterioration, disordered thinking (including delusions), disordered perception, (including hallucinations), and flight of ideas are symptoms of psychotic behavior. It is uncommon for a psychotic patient to maintain eye contact.

DIF: Cognitive Level: Comprehension REF: p. 262 | p. 263 OBJ: 1 NAT: NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Psychosis 2. Which explanation(s) describe why a combination of antipsychotic agents with

benzodiazepines useful in initial treatment of the agitated patient? (Select all that apply.) a. Antipsychotics are not effective for 2 days. b. Benzodiazepines allow for lower dosages of antipsychotic agents to be used, thereby decreasing serious adverse effects seen with high-dose therapy. c. It assists in calming the psychotic patient. d. It allows for rapid increase in dosing of the antipsychotic agents to expedite treatment of hallucinations. e. It effectively treats extrapyramidal adverse effects associated with antipsychotic agents.

ANS: B, C

The use of benzodiazepines allows lower dosages of antipsychotic agents to be used.

Benzodiazepines assist in calming the agitated psychotic patient. Antipsychotic medications can be effective in a matter of minutes when injected. Benzodiazepines do not facilitate the increase of antipsychotic medications or treat extrapyramidal adverse effects associated with antipsychotic agents.

DIF: Cognitive Level: Comprehension REF: p. 263 | p. 264 OBJ: 2 | 3 NAT: NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment 3. Which is/are extrapyramidal adverse effect(s) of antipsychotic agents? (Select all that apply.) a. Spasmodic movements of muscle groups b. Mask-like expression c. Lip smacking d. Inability to sit in one place for an extended period e. Weight gain ANS: A, B, C, D

Dystonic reactions, pseudoparkinsonism, tardive dyskinesia, and akathisia are extrapyramidal symptoms of antipsychotic agents. Antipsychotic drug therapy often causes substantial weight gain, but this is not classified as an extrapyramidal adverse effect.

DIF: Cognitive Level: Comprehension REF: p. 268 | p. 269 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 4. Which sign(s) and symptom(s) may occur in neuroleptic malignant syndrome? (Select all that

apply.) a. Fever b. Hypertension c. Severe extrapyramidal symptoms d. Alterations in consciousness e. Bradycardia ANS: A, B, C, D

Fever, severe extrapyramidal symptoms, hypertension, and alterations in consciousness (such as stupor, mutism, and coma) are characteristic of neuroleptic malignant syndrome.

Bradycardia is not a sign of neuroleptic malignant syndrome.

DIF: Cognitive Level: Knowledge REF: p. 269 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment 5. Which adverse effect(s) may occur as a result of antipsychotic drug therapy? (Select all that

apply.) a. Acute dystonia b. Akathisia c. Weight loss d. Neuroleptic malignant syndrome e. Hypoglycemia f. Tardive dyskinesia ANS: A, B, D, F

Antipsychotic drugs can cause neuroleptic malignant syndrome and motor dysfunctions such as dystonia, akathisia, and tardive dyskinesia. Antipsychotic drugs may cause weight gain and hyperglycemia.

DIF: Cognitive Level: Knowledge REF: p. 268 | p. 269 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Psychosis 6. Which actions will the nurse take when a patient admitted to a psychiatric facility is

hallucinating, pacing, and acting highly suspicious? (Select all that apply.) a. Use the most restrictive restraints available to subdue the patient. b. Be open and direct when handling the patient. c. Encourage a variety of interactions with others. d. Provide high-protein, high-calorie foods. e. Reinforce hallucinations.

ANS: B, D

Nursing interventions for patients with psychosis must be individualized and based on patient assessment data. The nurse should be open and direct when handling patients who are highly suspicious. High-protein, high-calorie foods are appropriate for the individual to eat while pacing or highly active. If physical restraints are necessary, they should be the least restrictive possible for the circumstances. Interactions should be minimized when perceptions are altered. Hallucinations should not be reinforced.

DIF: Cognitive Level: Application REF: p. 271 | p. 272 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment | NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Psychosis | Sensory Perception 7. Which statement(s) will be included when educating an elderly patient and family about

antipsychotic drug therapy? (Select all that apply.) a. Hallucinations may be reduced within 1 week of starting. b. Rapid increase in dosages will increase the frequency of adverse effects. c. Older patients should be observed for hypertension. d. Tardive dyskinesia may be reversible in early stages. e. Full therapeutic response may require 6 to 8 weeks to be achieved.

ANS: B, D, E

Rapid increases in dosages of antipsychotic medication will not reduce the antipsychotic response time but will increase the frequency of adverse effects. Tardive dyskinesia may be reversible in early stages, but it becomes irreversible with continued use of the antipsychotic medication. Reduction in hallucinations, delusions, and thought disorders often requires 6 to 8 weeks for a full therapeutic response to be achieved. Older patients should be observed for hypotension.

DIF: Cognitive Level: Comprehension REF: p. 263 | p. 264 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

Chapter 18: Drugs Used for Seizure Disorders Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which condition is associated with hydantoin therapy? a. Postictal state b. Atonia c. Seizure threshold reduction d. Gingival hyperplasia ANS: D

Encouraging good oral hygiene practices is indicated when a patient is on hydantoin therapy because its use contributes to gingival hyperplasia. Postictal state is a characteristic of generalized tonic-clonic seizures. Atonia is not associated with hydantoin therapy. Hydantoin raises the seizure threshold.

DIF: Cognitive Level: Knowledge REF: p. 282 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 5

2. Which symptom is most likely to be assessed in a patient prescribed hydantoin therapy with a

history of diabetes who has just been diagnosed with seizure disorder? a. Hunger b. Hyperglycemia c. Diarrhea d. Pupil dilation ANS: B

Hydantoins may elevate blood sugar levels. Hunger, diarrhea, and pupil dilation are adverse effects of hydantoin therapy. Constipation and nystagmus are potential adverse effects.

DIF: Cognitive Level: Application REF: p. 284 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety

OBJ: 5

3. Which guideline should be followed when administering phenytoin (Dilantin) intravenously? a. Deliver rapidly. b. Monitor for signs of tachycardia. c. Assess for hypertensive crisis. d. Administer without mixing with other medications.

ANS: D

Phenytoin should not be mixed in the same syringe with other medications or added to other intravenous (IV) solutions because a precipitate will form. Phenytoin should be administered slowly at a rate of 25 to 50 mg/min. Patients should be monitored with an ECG closely for bradycardia. Patients should be monitored for hypotension.

DIF: Cognitive Level: Application REF: p. 284 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: N/A CON: Clinical Judgment

4. Which condition may the patient have carbamazepine (Tegretol) prescribed to treat

symptoms? a. Tardive dyskinesia b. Psychotic episodes c. Trigeminal neuralgia pain d. Sedation ANS: C

Carbamazepine has been used successfully to treat pain associated with trigeminal neuralgia and for bipolar disorders when lithium therapy has not been optimal. Carbamazepine does not have antidepressant, antipsychotic, or sedative effects.

DIF: Cognitive Level: Knowledge REF: p. 286 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Pain

5. Which drug of choice is prescribed for treating a generalized tonic-clonic seizure? a. Diazepam (Valium) b. Haloperidol (Haldol) c. Valproic acid (Depakene) d. Risperidone (Risperdal) ANS: C

Anticonvulsant therapy should start with the use of a single agent selected from a group of first-line agents based on the type of seizure. Valproic acid is indicated for generalized tonic-clonic seizures. Diazepam is not the drug of choice for treatment of tonic-clonic seizures. Haloperidol is an antipsychotic medication. Risperidone is an antipsychotic agent.

DIF: Cognitive Level: Comprehension REF: p. 295 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment 6. Which response by the nurse is accurate when a patient who has been on lamotrigine

(Lamictal) for seizure control reports a skin rash and urticaria? a. Reassure the patient that this is a common adverse effect of the medication and not to worry. b. Instruct the patient to discontinue use of the drug immediately. c. Instruct the patient to decrease the dosage of the medication until the rash disappears. d. Advise the patient that this adverse effect usually resolves but should be reported to the healthcare provider.

ANS: D

The healthcare provider should be notified promptly because the rash could be an indicator of a more serious condition. The nurse is not authorized to recommend dosage changes to the patient. The nurse should not trivialize the patient‘s concern about the adverse effect; it is common only in 10% of patients who take lamotrigine and can lead to more serious adverse effects. The nurse should not recommend discontinuing the medication without orders from the healthcare provider. This is not a common adverse effect and should be monitored.

Approximately 10% of patients receiving lamotrigine develop a skin rash in the first 4 to 6 months of therapy.

DIF: Cognitive Level: Application REF: p. 289 OBJ: 5 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education 7. Which medication is used to control seizures or prevent migraine headaches? a. Topiramate (Topamax) b. Zonisamide (Zonegran) c. Valproic acid (Depakene) d. Tiagabine (Gabitril) ANS: A

Topiramate has been approved for adults in the prevention (but not treatment) of migraine headaches. Zonisamide, valproic acid, and tiagabine do not affect migraine headaches.

DIF: Cognitive Level: Knowledge REF: p. 294 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 4 CON: Clinical Judgment

8. Which condition would indicate to the nurse that a patient has phenytoin (Dilantin) toxicity? a. Oculogyric crisis b. Nystagmus c. Strabismus d. Amblyopia ANS: B

Nystagmus (involuntary rhythmic, uncontrollable movements of one or both eyes) may be a sign of phenytoin toxicity. Oculogyric crisis is an adverse effect of some antipsychotic medications. Strabismus is a visual disorder in which the eyes are misaligned and point in different directions. Amblyopia is a loss of visual acuity in the nondominant eye caused by lack of use of the eye in early childhood.

DIF: Cognitive Level: Comprehension REF: p. 284 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety 9. Which information would be most important for the nurse to provide to a patient when

teaching about the adverse effects of succinimide therapy? a. Nausea, vomiting, and indigestion are common during the initiation of therapy. b. Avoid taking the medication with food or milk to minimize adverse effects. c. Sedation, drowsiness, and dizziness tend to worsen with continued therapy. d. Reducing the dosage of medication will relieve symptoms of nausea.

ANS: A

Nausea, vomiting, and indigestion are common during initiation of therapy. Taking the medicine with food or milk reduces the nausea and indigestion. Sedation, drowsiness, and dizziness tend to disappear with continued therapy. Gradual increases in dosage tend to decrease nausea and vomiting.

DIF: Cognitive Level: Comprehension REF: p. 285 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 5

10. Which dose is within the acceptable range for administering IV phenytoin (Dilantin) to a

patient with a seizure disorder? a. 5 mg/min b. 30 mg/min c. 60 mg/min d. 100 mg/min ANS: B

Phenytoin is administered slowly at a rate of 25 to 50 mg/min. A rate of 5 mg/min is too slow.

A rate of 60 mg/min or 100 mg/min is too fast.

DIF: Cognitive Level: Comprehension REF: p. 284 NAT: NCLEX Client Needs Category: Physiological Integrity

OBJ: N/A

TOP: Nursing Process Step: Implementation

CON: Clinical Judgment | Safety

11. Which patient statement indicates a need for further teaching about phenytoin (Dilantin)

prescribed to manage a seizure disorder? a. ―I need to avoid or limit caffeine intake.‖ b. ―I will check with the pharmacist before taking over-the-counter medication.‖ c. ―If I develop enlarged gums, I will stop taking the medication.‖ d. ―It is important for me to take my medicine at the same time daily.‖ ANS: C

Medications are not discontinued unless approved by the healthcare provider. Gingival hyperplasia is a common adverse effect that can be reduced by oral hygiene. Limiting caffeine intake, checking with the pharmacist about any additional over-the-counter medications, and taking the medication at the same time every day are appropriate actions by the patient.

DIF: Cognitive Level: Application REF: p. 284 OBJ: 5 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education 12. Which premedication assessment by the nurse is most important prior to the initiation of

carbamazepine (Tegretol) therapy? a. Determine patient‘s ancestry. b. Monitor blood pressure (BP) lying, sitting, and standing. c. Auscultate lung sounds. d. Obtain smoking history.

ANS: A

The nurse needs to review the patient‘s history to exclude Asian ancestry, including South Asian Indians. If the patient does have this ancestry, bring it to the prescriber‘s attention so that genetic testing may be completed. BP monitoring is important and hypotension is an adverse effect, but it is not as significant to monitor prior to the initiation of therapy. Lung sound assessment and smoking history assessment are important assessments, but not prior to the initiation of carbamazepine therapy.

DIF: Cognitive Level: Application REF: p. 286 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 13. Which statement by the patient recently prescribed pregabalin (Lyrica) indicates a need for

further instruction? a. ―I may feel tired at first, but this should improve with continued use.‖ b. ―Once my pain improves, I will stop taking this medication.‖ c. ―Taking sleeping aids will increase the sedative effect of this medication.‖ d. ―This drug may affect my mental alertness, so I need to be careful around machinery.‖ ANS: B

When discontinuing therapy, taper over at least 1 week to minimize the potential for withdrawal symptoms. Drowsiness tends to disappear with continued use of the medication.

Sleeping aids enhance the sedative effects of pregabalin. Pregabalin causes sedation, so people who work around machinery, drive a car, or perform other duties in which they must remain mentally alert should be particularly cautious.

DIF: Cognitive Level: Application REF: p. 293 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Patient Education 14. Which food should be removed from the tray of a pediatric patient on a ketogenic diet for

refractory seizure control? a. Fat b. Salt c. Carbohydrates d. Vitamin K ANS: C

The ketogenic diet is used in children and includes restriction of carbohydrate and protein intake. Fat is the primary fuel that produces acidosis and ketosis in the ketogenic diet. Salt and vitamin K are not restricted in the ketogenic diet.

DIF: Cognitive Level: Application REF: p. 279 OBJ: N/A NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Patient Education | Development | Nutrition MULTIPLE RESPONSE 1. Which action(s) is/are appropriate in the nursing management of a patient with generalized

tonic-clonic seizure activity? (Select all that apply.) a. Restraining the patient‘s arms to avoid further injury b. Placing padding around or under the patient‘s head c. Attempting to insert a tongue depressor into the patient‘s mouth d. Positioning the patient on the side once the relaxation stage is entered to allow oral secretions to drain e. Requesting additional assistance and/or necessary equipment in case the patient does not begin breathing spontaneously when the seizure is over ANS: B, D, E

Managing a patient during a seizure includes protecting the patient from further injury, (placing padding around or under the head to help prevent head injury), positioning the patient in the recovery position to facilitate respiratory effort, clearing the airway, and initiating ventilations should the patient lack spontaneous respirations after seizure. Restraining a patient who is having a seizure can cause, rather than prevent, injury. Inserting anything into the mouth of someone who is having a seizure can cause injury.

DIF: Cognitive Level: Application REF: p. 278 OBJ: 2 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety

2. Which important nursing interventions(s) is/are associated with administration of diazepam

(Valium) 10 mg IV stat for a patient admitted with status epilepticus? (Select all that apply.) a. Apply a cardiac monitor to the patient to assess for continuous heart rate, if not already done. b. Administer the prescribed dosage over 1 minute. c. Mix diazepam in a primary IV solution to avoid overdosing. d. Continuously assess the patient‘s airway. e. Obtain the correct dose (10 mg) and administer over slow IV push.

ANS: A, D, E

It is important to monitor the patient for bradycardia during administration of diazepam.

During a seizure of any type, it is important to assess for airway patency continuously.

Diazepam should be administered slowly by the IV route at a rate of no more than 5 mg/min.

For status epilepticus, 5 to 10 mg is typical, preferably by slow IV. The dose may be repeated every 5 to 10 minutes, up to a total dosage of 30 mg. If necessary, repeat therapy in 2 to 4 hours; other drugs are preferable for long-term control. Diazepam is incompatible with most other IV medications and should not be combined.

DIF: Cognitive Level: Application REF: p. 280-283 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 2 CON: Clinical Judgment | Safety

3. Which adverse effect(s) should patients taking phenytoin (Dilantin) for control of seizures be

aware can occur? (Select all that apply.) a. Blood dyscrasias b. Hyperglycemia c. Urinary retention d. Gingival hyperplasia e. Insomnia f. Sedation ANS: A, B, D, F

Phenytoin may cause blood dyscrasias, gingival hyperplasia, and sedation and may elevate blood glucose levels, especially if higher doses are used. Urinary retention and insomnia are not adverse effects of phenytoin.

DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: Assessment

REF: p. 283 OBJ: 5 CON: Clinical Judgment | Patient Education | Safety

4. The nurse is preparing to administer zonisamide (Zonegran) to a newly admitted patient with

the diagnosis of adult partial seizures. Which sign(s) or symptom(s) would cause the nurse to hold this medication? (Select all that apply.) a. Skin rash b. Urinary frequency c. Drowsiness d. Allergy to Bactrim e. Pruritus ANS: A, D, E

Zonisamide should not be administered without specific approval if the patient has an allergy to Bactrim or a dermatologic reaction such as a skin rash and/or pruritus. Urinary frequency is not associated with zonisamide. Drowsiness is a common adverse effect of zonisamide.

DIF: Cognitive Level: Comprehension REF: p. 296 | p. 297 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 5. A patient on anticonvulsant therapy confides to the nurse at an outpatient clinic that she

suspects she may be pregnant. Which action(s) should the nurse encourage the patient to take?

(Select all that apply.) a. Consult an obstetrician. b. Discontinue medications. c. Carry an identification card. d. Provide a list of seizure medications. e. Consider oral contraception.

ANS: A, C, D

Pregnancy considerations include encouraging the patient to consult with an obstetrician, provide a list of seizure medications, and carry an identification card. Medications should not be discontinued unless told to do so by the healthcare provider. If pregnancy is suspected, oral contraceptives should not be encouraged.

DIF: Cognitive Level: Application REF: p. 281 OBJ: 4 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety | Development

Chapter 19: Drugs Used for Pain Management Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which type of pain scale assessment tool is the most accurate to use when completing an

assessment on a nonverbal adult patient? a. TPPPS b. FLACC c. POCIS d. MOPS ANS: B

The Face, Legs, Activity, Cry, Consolability (FLACC) scale would be used to assess pain in the nonverbal patient. The Toddler Preschooler Postoperative Pain Scale (TPPPS), Pain Observation Scale for Young Children (POCIS), and Modified Objective Pain Scale (MOPS) would not be appropriate for this patient.

DIF: Cognitive Level: Comprehension REF: p. 304 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Pain

2. Which action will the nurse take when a patient receiving morphine sulfate via percutaneous

coronary angioplasty (PCA) has a shallow, irregular respiratory rate of 6 breaths/min? a. Elevate the patient‘s head of bed to facilitate lung expansion. b. Increase the patient‘s primary intravenous (IV) flow rate. c. Complete the FLACC scale. d. Notify the healthcare provider and prepare to administer naloxone (Narcan).

ANS: D

The patient is exhibiting signs of respiratory depression. Administration of the antidote naloxone would be the most appropriate nursing intervention. Lung expansion or increasing the primary IV infusion rate would not relieve respiratory depression. Assessing the patient‘s pain at this point is a lesser priority than treating the respiratory depression.

DIF: Cognitive Level: Application REF: p. 316 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Gas Exchange

OBJ: 3 | 4

3. Which patient assessment would indicate to the nurse that salicylate toxicity is occurring? a. Gastrointestinal (GI) bleeding b. Increased bleeding times c. Tinnitus d. Occasional nausea ANS: C

Symptoms of salicylism include ringing in the ears (tinnitus), impaired hearing, dimming of vision, sweating, fever, lethargy, dizziness, mental confusion, nausea, and vomiting. Although salicylates may cause GI bleeding over time, it is not a symptom associated with toxicity.

Increased bleeding time is an effect associated with the treatment of clots. Occasional nausea is a common adverse effect of treatment with salicylates; it is not a sign of toxicity.

DIF: Cognitive Level: Comprehension REF: p. 322 OBJ: 6 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 4. Which advantage relates to taking a nonsteroidal antiinflammatory drug (NSAID) that is a

COX-2 inhibitor? a. The medication is cheaper than aspirin. b. There are fewer GI adverse effects. c. They are more effective than COX-1 inhibitors. d. They have no known adverse effects.

ANS: B

COX-2 inhibitor NSAIDs have fewer GI adverse effects than salicylates or COX-1 inhibitors.

Aspirin is one of the least expensive analgesics available. The antiinflammatory actions of NSAIDs are caused by COX-2 inhibition; the unwanted adverse effects are caused by inhibition of COX-1. All these medications have adverse effects.

DIF: Cognitive Level: Knowledge REF: p. 325 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Patient Education | Safety

5. An 86-year-old patient who was admitted with GI bleeding as a result of salicylate therapy is

being discharged. As the nurse reviews the discharge medication list, the patient states that she doesn‘t understand why Tylenol doesn‘t work as well as the aspirin she had been taking.

Which response is best? a. ―Tylenol and aspirin are chemically the same drug.‖ b. ―Tylenol is appropriate for only minor pain.‖ c. ―Tylenol does not help with inflammatory discomfort.‖ d. ―A therapeutic blood level must be established with Tylenol.‖ ANS: C

Acetaminophen (Tylenol) is effective as an analgesic or antipyretic. Tylenol does not possess any antiinflammatory activity and is therefore ineffective in relieving symptoms related to inflammation. Tylenol and aspirin are distinctly different drugs. Tylenol can be useful in the relief of moderate pain. Tylenol can be effective in a single dose, without needing treatment over a period of time.

DIF: Cognitive Level: Comprehension REF: p. 320 OBJ: 5 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Pain 6. Which term is used to define an awareness of pain? a. Tolerance b. Threshold c. Perception d. Sensation ANS: C

Pain perception, also known as nociception, is an individual‘s awareness of the feeling of pain. Pain tolerance is an individual‘s ability to endure pain. Pain threshold is the point at which an individual first acknowledges or interprets a sensation as being painful. Pain is a sensation characterized by a group of unpleasant perceptual and emotional experiences that trigger autonomic, psychological, and somatomotor responses.

DIF: Cognitive Level: Knowledge REF: p. 300 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Pain 7. Which statement is true about neuropathic pain? a. This pain is the result of a stimulus to pain receptors. b. Patients describe it as dull and aching. c. It commonly originates in the abdominal region. d. The pain is a result of nerve injury.

ANS: D

Neuropathic pain results from injury to the peripheral or central nervous system, such as trigeminal neuralgia. Nociceptive pain is the result of a stimulus to pain receptors.

Nociceptive pain is usually described as dull and aching. Visceral pain originates from the abdominal and thoracic regions.

DIF: Cognitive Level: Comprehension REF: p. 301 NAT: NCLEX Client Needs Category: Physiological Integrity

OBJ: 1

TOP: Nursing Process Step: Assessment

CON: Clinical Judgment | Pain

8. Which time period identifies how long after the administration of a parenteral pain medication

the nurse will complete the next pain assessment to evaluate the effectiveness of the medication? a. 10 minutes b. 30 minutes c. 1 hour d. 2 hours ANS: B

Evaluation of pain effectiveness of parenteral pain medications needs to occur within 15 to 30 minutes of administration. Ten minutes, one hour, and two hours are not accurate time frames to evaluate the effectiveness of parenteral medications.

DIF: Cognitive Level: Comprehension REF: p. 303 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Pain 9. Which sign or symptom displayed by a patient would be indicative of opiate withdrawal? a. Bradycardia b. Diarrhea c. Lethargy d. Hypothermia ANS: B

Symptoms of opiate withdrawal include muscular spasms; severe aches in the back, abdomen, and legs; abdominal and muscle cramps; hot and cold flashes; insomnia; nausea, vomiting, and diarrhea; severe sneezing; and increases in body temperature, blood pressure, and respiratory and heart rates. Bradycardia is not a sign of opiate withdrawal; increased heart rate is a sign of opiate withdrawal. Lethargy is not a sign of opiate withdrawal; restlessness is a sign of opiate withdrawal. Hypothermia is not a sign of opiate withdrawal; fever is a sign of opiate withdrawal.

DIF: Cognitive Level: Comprehension REF: p. 311 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Elimination | Addiction 10. Which medication is contraindicated when a patient is taking warfarin (Coumadin)? a. Aspirin b. Acetaminophen (Tylenol) c. Propoxyphene (Darvon) d. Morphine (Roxanol) ANS: A

Salicylates enhance the anticoagulant effect of warfarin. Acetaminophen, propoxyphene, and morphine are not contraindicated with warfarin use.

DIF: Cognitive Level: Comprehension REF: p. 322 OBJ: 6 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Patient Education | Safety

11. Which way is best for the nurse to evaluate the effectiveness of the patient‘s opiate agonist? a. Ability of the patient to tolerate more activity b. Increased sleep time throughout the night c. Reduction of respiratory rate from 24 to 18 breaths/min d. Verbal report of 2 on a 1 to 10 scale ANS: D

A verbal report is the best indicator because pain is individually perceived and using a pain rating scale is a consistent manner of assessment. Toleration of activity and an increased sleep pattern are not the most accurate methods of pain evaluation. Reduction of respiratory rate is not an appropriate measurement of pain control.

DIF: Cognitive Level: Comprehension REF: p. 304 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Pain 12. Which medication would the nurse administer to a patient who is rating the pain at 8 on a 0 to

10 scale? a. Acetaminophen (Tylenol) b. Morphine (Roxanol) c. Oxycodone (OxyContin) d. Oxycodone and aspirin (Percodan) ANS: B

Severe pain is treated with an opiate agonist (i.e., morphine). Severe pain is not treated with acetaminophen, oxycodone, or Percodan.

DIF: Cognitive Level: Application REF: p. 310 | p. 311 | p. 312 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Pain 13. Which situation indicates the need to withhold an opiate agonist? a. Evidence of postural hypotension b. Presence of constipation c. Pain rating of 7 on a 0 to 10 scale d. Respiratory rate of 10 breaths/min ANS: D

The nurse would withhold the medication if respirations are less than 12 breaths/min. Postural hypotension is a common adverse effect that most frequently occurs when therapy is initiated.

Providing for patient safety is important, but it does not warrant withholding the medication.

Constipation is an expected adverse effect and does not warrant withholding an opiate agonist.

A pain rating of 7 would not warrant holding an opiate agonist.

DIF: Cognitive Level: Application REF: p. 315 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 14. Which information is most accurate regarding the nurse‘s understanding of pain management? a. Older patients have difficulty describing their pain level. b. Encourage patients to report pain before the pain becomes too severe. c. Use the smallest dose of medication possible to control pain.

d. Pain medication administration ordered PRN will maintain a constant blood level.

ANS: B

Even though pain medicine administration may be scheduled, encourage the patient to request pain medication before the pain escalates and becomes severe. Although the smallest dose possible to control the pain is the goal of therapy, it is also important that the dose be sufficient to provide adequate relief. Older patients are able to describe pain; a variety of tools are available for a variety of patient populations. Analgesics given on a scheduled basis every 3 to 4 hours will maintain a more constant plasma level.

DIF: Cognitive Level: Comprehension REF: p. 309 | p. 310 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Pain 15. Which component of the pain history is being addressed when a patient describes pain as

cramping and burning? a. Depth b. Location c. Quality d. Severity ANS: C

The actual sensation of the pain is often described as stabbing, dull, cramping, sore, burning, or a combination of these. Depth of pain, location of pain, and severity of pain are not described as cramping and burning.

DIF: Cognitive Level: Comprehension REF: p. 305 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Pain 16. A patient experiencing chronic pain as a result of metastatic cancer has a new order for

fentanyl (Duragesic) transdermal patch. The initial patch is applied at 8 AM on Monday. At 8 PM on Monday, the patient reports a pain level of 8. Which action should be taken? a. Immediately contact the physician. b. Reassess pain level in 30 to 45 minutes. c. Remove current patch and reapply a new patch. d. Provide a PRN analgesic medication as ordered.

ANS: D

The fentanyl (Duragesic) patch takes approximately 12 to 24 hours for the initial patch of medication to reach a steady blood level, so other analgesics must be used during this time.

Therefore, it is not necessary to immediately contact the physician. The patient is reporting severe pain and requires immediate intervention to help relieve this discomfort.

DIF: Cognitive Level: Application REF: p. 309 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 2 CON: Clinical Judgment | Pain

17. A patient is taking meperidine (Demerol) as needed for moderate to severe pain following an

open appendectomy. The nurse assesses the following: current pain level 2, temperature 99F, BP 130/76, respirations 10, lung sounds clear, abdomen soft and tender, bowel sounds present. Which is the primary problem based on this assessment information? a. Breathing pattern alteration b. Altered body temperature c. Constipation d. Pain ANS: A

Meperidine (Demerol) is an opiate agonist and can cause respiratory depression. Respirations less than 12/min indicate altered breathing pattern and require immediate intervention.

Temperature of 99F is not the priority concern. The abdomen is soft, so there is no indication of constipation. Pain level of 2 is considered mild; therefore, this is not the top priority.

DIF: Cognitive Level: Analysis REF: p. 315 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Diagnosis CON: Clinical Judgment | Gas Exchange MULTIPLE RESPONSE 1. Which additional nursing intervention(s) would be effective with pain management in the

pediatric population? (Select all that apply.) a. Provide diversional activities such as coloring, puzzles, and games. b. Allow uninterrupted sleep and rest. c. Perform hygiene measures. d. Encourage parental participation with caregiving to diminish the child‘s anxiety. e. With the healthcare provider‘s approval, encourage the child to drink eight to ten 8-ounce glasses of fluid daily.

ANS: A, B, C, D

Diversional activities, adequate sleep, comfort measures (such as hygiene), and parental participation with care are alternative nursing interventions that may be used in pain management. Forcing fluids is not likely to assist with pain management in the child.

DIF: Cognitive Level: Application REF: p. 307 | p. 308 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Pain | Development 2. Which common adverse effect(s) is/are associated with opiate agonists? (Select all that

apply.) a. Dizziness b. Orthostatic hypotension c. Respiratory depression d. Confusion e. Diarrhea f. Urinary urgency ANS: A, B, C, D

Dizziness, orthostatic hypotension, respiratory depression, and confusion are adverse effects associated with opiate agonists. Constipation, not diarrhea, is an adverse effect associated with opiate agonists. Urinary retention, not urgency, is an adverse effect associated with opiate agonists.

DIF: Cognitive Level: Comprehension REF: p. 311 | p. 315 | p. 316 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 3. Which condition(s) may be managed by salicylates? (Select all that apply.) a. Migraine headache b. Swollen joints c. Fever d. Muscle aches e. Myocardial infarction ANS: B, C, D, E

Salicylates inhibit prostaglandins that produce the signs and symptoms of inflammation, inhibit the synthesis and release of prostaglandins in the brain that cause the elevation of body temperature, inhibit the formation of prostaglandins that sensitize pain receptors (providing analgesia), and inhibit platelet aggregation and decrease the risk of clot development.

Salicylates are not typically used for migraine headache.

DIF: Cognitive Level: Comprehension REF: p. 321 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Pain | Inflammation | Perfusion 4. Which drugs should be addressed when teaching a patient who is starting therapy with

NSAIDs? (Select all that apply.) a. Warfarin (Coumadin) b. Lithium (Eskalith) c. Hydroxyzine (Vistaril) d. Insulin e. Diuretics f. Digitalis (Digoxin) ANS: A, B, E

NSAIDs may enhance the effects of warfarin, lithium, and diuretics. NSAIDs are not known to interact with hydroxyzine, insulin, or digitalis.

DIF: Cognitive Level: Knowledge REF: p. 327 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Patient Education | Safety 5. Which patient characteristic(s) will be assessed when performing a baseline neurologic

assessment prior to the administration of an NSAID medication? (Select all that apply.) a. Vital signs b. Orientation to date, time, and place c. Mental alertness d. Bowel sounds e. Concurrent use of anticoagulant agents

ANS: B, C

Orientation to date, time, and place as well as assessment of mental alertness is a component of a baseline neurologic assessment to be completed prior to medicating with an NSAID. Vital signs, bowel sounds, and assessment of concurrent use of anticoagulant drugs are not considered components of a neurologic assessment.

DIF: Cognitive Level: Comprehension REF: p. 326 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Pain

Chapter 20: Introduction to Cardiovascular Disease and Metabolic Syndrome Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which weight category applies to a patient with a body mass index (BMI) of 25? a. Underweight b. Normal weight c. Overweight d. Obese ANS: C

A BMI of less than 18.5 is considered underweight. A BMI of 18.5 to 24.9 is considered normal weight. A BMI of 25 to 29.9 is considered overweight. A BMI of 30 to 34.9 is considered obesity, class I; 35 to 39.9 is considered obesity, class II; and more than 40 is considered extreme obesity.

DIF: Cognitive Level: Knowledge REF: p. 331 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Nutrition | Health Promotion 2. Which approach is the most critical when treating metabolic syndrome? a. Psychotherapy b. Pharmacotherapy c. Lifestyle management d. Patient education ANS: C

Lifestyle management is critical for managing metabolic syndrome; other approaches will not be effective without it. Psychotherapy, pharmacotherapy, and patient education are not the most critical approaches to treating metabolic syndrome.

DIF: Cognitive Level: Comprehension REF: p. 330 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Nutrition | Health Promotion 3. Which percentage identifies the least amount of saturated fat based on total calories included

in a healthy diet? a. 30% b. 10% c. 7%

d. 2% ANS: C

A healthy diet should have no more than 7% of calories from saturated fat. A diet with 30% or 10% saturated fat would not be considered a healthy diet. A diet can have up to 7% saturated fat before it is considered unhealthy.

DIF: Cognitive Level: Knowledge REF: p. 332 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Nutrition | Health Promotion 4. Which ethnic group or gender is at greatest risk for developing metabolic syndrome? a. Hispanic women b. Asian men c. African-American men d. White women ANS: A

Hispanic women have the highest incidence rate of metabolic syndrome at 27%. Asian men, African-American men, and white women are not at the highest risk for metabolic syndrome.

DIF: Cognitive Level: Knowledge REF: p. 331 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Nutrition | Health Promotion 5. Which incidence is the correct representation of metabolic syndrome in the United States? a. 1 in 3000 b. 1 in 300 c. 1 in 30 d. 1 in 3 ANS: D

The incidence of metabolic syndrome in the United States is 1 in 3, or about 50 million adults.

One in 3000, one in 300, and one in 30 are each less than the incidence of metabolic syndrome in the United States.

DIF: Cognitive Level: Comprehension REF: p. 331 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Nutrition | Health Promotion 6. Which mechanism of action is demonstrated by exercise in managing blood glucose levels? a. Exercise causes release of glucose and promotes a reduced blood glucose level. b. Exercise on a regular basis causes a reduction in lean body mass, which helps

regulate blood glucose levels. c. Increased muscle mass and less fat tends to normalize blood glucose levels

because glucose is used by muscle cells when exercising. d. Exercise stimulates the liver, the primary storage and utilization site of glucose, to

release glucose.

ANS: C

Exercise leads to more muscle and less fat, so blood glucose levels tend to return to normal.

Exercise increases the rate of glucose uptake in the contracting skeletal muscles. Exercise on a regular basis prevents reduction in lean body mass and protein wasting. The liver is not the primary storage and utilization site of glucose.

DIF: Cognitive Level: Comprehension REF: p. 335 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Nutrition | Health Promotion 7. Which instruction by the nurse is accurate to include in a patient‘s care to manage metabolic

syndrome? a. Encourage the client to exercise 20 minutes every day. b. Eliminate alcohol intake. c. Increase simple carbohydrates in the diet. d. Reduce stress.

ANS: D

Stress reduction is important in the management of metabolic syndrome. Twenty minutes of exercise is not adequate. Alcohol intake needs to be restricted but does not have to be eliminated. Complex carbohydrates are appropriate in the management of metabolic syndrome.

DIF: Cognitive Level: Comprehension REF: p. 332 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Nutrition | Health Promotion | Patient Education MULTIPLE RESPONSE 1. What lifestyle choice(s) may aggravate metabolic syndrome? (Select all that apply.) a. Excessive tobacco smoking b. Inadequate hydration c. Excessive exercise d. Inadequate caloric intake e. Excessive consumption of alcohol ANS: A, E

Smoking and excessive consumption of alcohol may aggravate metabolic syndrome.

Metabolic syndrome is not directly affected by inadequate hydration. Metabolic syndrome is directly affected by a sedentary lifestyle, not excessive exercise. Metabolic syndrome is directly affected by increased, not inadequate, caloric intake.

DIF: Cognitive Level: Knowledge REF: p. 332 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Nutrition | Health Promotion 2. Which condition(s) is/are associated with metabolic syndrome in addition to type 2 diabetes

and heart disease? (Select all that apply.) a. Dementia b. Insomnia c. Renal disease

d. Obstructive sleep apnea e. Orthostatic hypotension f. Polycystic ovary syndrome ANS: A, C, D, F

Dementia, renal disease, obstructive sleep apnea, and polycystic ovary syndrome are associated with metabolic syndrome. Insomnia and orthostatic hypotension are not associated with metabolic syndrome.

DIF: Cognitive Level: Knowledge REF: p. 331 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Nutrition | Health Promotion 3. Which condition(s) are the target(s) for drug therapy to control during the initial treatment of

metabolic syndrome? (Select all that apply.) a. Obstructive sleep apnea b. Diabetes mellitus c. Hypertension d. Obesity e. Dyslipidemia f. Insulin resistance ANS: B, C, E

Pharmacologic approaches to managing metabolic syndrome are targeted toward controlling diabetes, hypertension, and dyslipidemia. There is no pharmacologic intervention for obstructive sleep apnea. Obesity should be addressed before pharmacologic therapy begins.

Insulin resistance is not dealt with pharmacologically in the early management of metabolic syndrome.

DIF: Cognitive Level: Knowledge REF: p. 335 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Nutrition | Health Promotion 4. Which cardiovascular condition(s) is/are related to coronary artery diseases (CADs)? (Select

all that apply.) a. Angina pectoris b. Pulmonary stenosis c. Acute myocardial infarction d. Pericarditis e. Venous stasis ulcers ANS: A, C

Angina pectoris and acute myocardial infarction are considered CADs. Pulmonary stenosis is a congenital heart disease. Pericarditis is inflammation of the tissue surrounding the heart.

Venous stasis ulcers are not related to CAD. DIF: Cognitive Level: Knowledge REF: p. 330 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Perfusion 5. Which key characteristic(s) is/are included in metabolic syndrome? (Select all that apply.) a. Hyperglycemia

b. c. d. e.

Abdominal obesity Low high-density lipoproteins Hypertension Osteoporosis

ANS: A, B, C, D

Metabolic syndrome is characterized by hyperglycemia, abdominal obesity, low high-density lipoproteins, and hypertension. Osteoporosis is not a characteristic of metabolic syndrome.

DIF: Cognitive Level: Comprehension REF: p. 331 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Nutrition | Health Promotion 6. Which action(s) should education for children in primary grades focus on to help prevent

metabolic syndrome? (Select all that apply.) a. Treatment of dyslipidemia b. Prevention of smoking c. Importance of moderate activity d. Discouraging use of alcohol e. Increase in saturated fat ANS: B, C, D

Primary prevention of metabolic syndrome is becoming a common thread in curriculum for children in the primary grades. This education focuses on the importance of moderate activity, dietary choices, and the prevention of alcohol and smoking. Treatment of dyslipidemia is not considered primary prevention. Diet should include reduced intake of saturated fat.

DIF: Cognitive Level: Comprehension REF: p. 334 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Nutrition | Health Promotion | Development COMPLETION 1. Weight: 140 lb. Height: 5 feet 4 inches. What is the BMI? ANS:

24.03 140 ÷ (64)2  703 = 24.03 DIF: Cognitive Level: Analysis REF: p. 331 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 2. Weight: 70 kg. Height: 164 cm (1.65 m). What is the BMI? ANS:

25.71 70 ÷ (1.65)2 = 25.71

DIF: Cognitive Level: Analysis REF: p. 331 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment

Chapter 21: Drugs Used to Treat Dyslipidemias Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which lipoprotein contributes to the development of atherosclerosis? a. Chylomicrons b. Very-low-density lipoprotein (VLDL) c. Low-density lipoprotein chylomicron (LDL C) d. High-density lipoprotein chylomicron (HDL C) ANS: C

The probability that atherosclerosis will develop is related directly to the concentration of LDL-C. Chylomicrons are intermediate-density lipoproteins. VLDLs are not as important in the development of atherosclerosis as low-density lipoproteins. HDLs do not contribute to the development of atherosclerosis.

DIF: Cognitive Level: Comprehension REF: p. 339 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Patient Education | Health Promotion 2. Which time period identifies the best time for the nurse to administer lovastatin (Mevacor)? a. 2 hours after breakfast b. During the patient‘s dinner c. 1 hour before breakfast d. 30 minutes before lunch ANS: B

Lovastatin should be administered with food to enhance absorption, and in the evening, because this is when the production of cholesterol is at its highest. It is not recommended that lovastatin be taken after food but while eating to enhance absorption. Taking the medication a half hour or an hour before eating would not benefit the patient or enhance absorption.

DIF: Cognitive Level: Comprehension REF: p. 344 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 3 CON: Clinical Judgment

3. The nurse has completed an admitting patient history and notes the patient‘s current

medications to be simvastatin (Zocor) and warfarin (Coumadin). Which result is expected with the interaction of these drugs? a. Abdominal distention b. Increased INR c. Low serum level of simvastatin d. Hypertension ANS: B

The combined therapy of simvastatin and warfarin may prolong the patient‘s INR. Additional nursing assessments would include monitoring for possible overcoagulation and bleeding.

Abdominal distention and a low serum level of simvastatin do not occur with the combined therapy of simvastatin and warfarin. Increased blood pressure is not a complication of combining simvastatin and warfarin therapy.

DIF: Cognitive Level: Comprehension REF: p. 345 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety

OBJ: N/A

4. Which deficiency may develop in patients taking cholestyramine? a. Potassium deficiency b. Sodium deficiency c. Vitamin K deficiency d. Hydrochloric acid deficiency ANS: C

Patients on long-term bile acid-sequestering resin therapy may become deficient in fatsoluble vitamins (i.e., D, E, A, K). Cholestyramine does not affect electrolyte levels or hydrochloric acid.

DIF: Cognitive Level: Knowledge REF: p. 346 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Patient Education | Health Promotion 5. Which possible adverse reaction related to vitamin K deficiency should a patient prescribed a

bile acid resin be instructed to report? a. Constipation b. Coffee-ground emesis c. Nausea d. Changes in skin pigmentation ANS: B

Vitamin K is essential for blood clotting. Signs and symptoms of a vitamin K deficiency include bleeding gums, bruising, dark tarry stools, and coffee-ground emesis (blood vomited from the stomach). Constipation, nausea, and a change in skin pigmentation are not signs of vitamin K deficiency.

DIF: Cognitive Level: Comprehension REF: p. 342 OBJ: 4 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Patient Education | Safety 6. Which vitamin has antilipemic actions? a. C b. A c. D d. B3 ANS: D

It is thought that niacin inhibits VLDL synthesis by liver cells, causing a decrease in LDL and triglyceride production. Vitamins A, C, and D do not have an antilipemic effects.

DIF: Cognitive Level: Knowledge REF: p. 348 OBJ: 4 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Health Promotion 7. Which rationale explains why statins, or HMG-CoA reductase inhibitors, are administered at

bedtime? a. The stomach is empty. b. Metabolic needs of the body are decreased. c. Cholesterol production is at its peak. d. The body temperature is increased.

ANS: C

The peak production of cholesterol is during the night. Therefore, HMG-CoA reductase inhibitors are more effective when administered at bedtime. Statins should be taken with food, not on an empty stomach. Metabolic needs of the body and body temperature do not affect the administration of statins.

DIF: Cognitive Level: Comprehension REF: p. 343 | p. 344 OBJ: 4 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment 8. Which desired effect applies to antilipemic therapy? a. Reduced LDLs and total cholesterol levels b. Reduced HDLs and total cholesterol levels c. Reduced LDLs and HDLs d. Reduced HDLs and dietary cholesterol levels ANS: A

LDLs account for 60% to 70% of total serum cholesterol and are a major contributor to atherosclerosis. The therapeutic outcome of antilipemic therapy is to lower the LDL and total cholesterol levels and raise the HDL and HDL/LDL ratio. HDLs are not reduced in treating hyperlipidemia.

DIF: Cognitive Level: Comprehension REF: p. 340 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment 9. Which symptoms, in addition to controlling hyperlipidemia, are bile acid–binding resins

prescribed to treat? a. Constipation secondary to excess fecal bile acids b. Constipation related to pseudomembranous colitis c. Pruritus secondary to biliary stasis d. Jaundice related to cholelithiasis ANS: C

Bile acid–binding resins may be used to treat pruritus as a result of partial biliary stasis.

Excess fecal bile acids produce diarrhea. Pseudomembranous colitis produces diarrhea. Bile acid–binding resins are not used to treat jaundice.

DIF: Cognitive Level: Comprehension REF: p. 345 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 4 CON: Clinical Judgment

10. Which antilipemic agent is most potent? a. Niacin b. HMG-CoA reductase inhibitor c. Bile acid–binding resin d. Fibric acid ANS: B

HMG-CoA reductase inhibitors are the most potent antilipemic agents available. Niacin, bile acid–binding resins, and fibric acid are not as potent as HMG-CoA reductase inhibitors.

DIF: Cognitive Level: Knowledge REF: p. 342 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 3 | 4 CON: Clinical Judgment

11. Which statement by the patient indicates a need for further teaching regarding statin therapy? a. ―I will take this medication at night.‖ b. ―This medication will reduce blood clot formation.‖ c. ―I will avoid drinking grapefruit juice.‖ d. ―If I get a headache, I will notify my healthcare provider.‖ ANS: D

Headaches are usually mild and disappear with continued therapy. Statins are to be taken at night. Statins reduce blood clot formation by reducing platelet aggregation and thrombin formation. Grapefruit juice inhibits the metabolism of this medication.

DIF: Cognitive Level: Comprehension REF: p. 344 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Patient Education 12. Which information given by the nurse to a patient recently prescribed niacin is accurate? a. ―Weigh yourself weekly because of the risk of fluid retention.‖ b. ―Nausea can be decreased if you take this medication with food.‖ c. ―Because your blood pressure may increase while taking this drug, have it checked

monthly.‖ d. ―You should not take aspirin while on this medication.‖ ANS: B

Niacin is administered with food to decrease gastrointestinal (GI) upset. Fluid retention and increased blood pressure are not adverse effects of niacin. Aspirin can minimize adverse effects and is safe to take.

DIF: Cognitive Level: Comprehension REF: p. 349 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 3

13. Which assessment in a patient being evaluated for hyperlipidemia will most increase the risk

of coronary artery disease (CAD)? a. Blood pressure, 168/90 mm Hg b. Hemoglobin A1c, 6% c. Walks 3 miles briskly, usually 4 days a week d. Eats five servings of fruits and vegetables daily ANS: A

Major treatable causes of CAD are hypertension, cigarette smoking, type 2 diabetes mellitus, and atherosclerosis. A hemoglobin A1c level of 6% does not increase the risk for CAD. Exercise and eating fruits and vegetables decrease the risk for CAD. DIF: Cognitive Level: Comprehension REF: p. 339 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 14. A patient is taking a HMG-CoA reductase inhibitor and reports muscle aches, soreness, and

weakness. The nurse suspects these symptoms to indicate early signs of myopathy. Which diagnostic test results will the nurse be sure to report when notifying the physician of these symptoms? a. Serum creatinine phosphokinase levels b. Red blood cell count c. Urine culture d. Echocardiogram ANS: A

Serum creatinine phosphokinase levels more than 10 times the upper limit of normal confirm the diagnosis of myopathy. Red blood cell and urine cultures and an echocardiogram would not confirm the diagnosis of myopathy.

DIF: Cognitive Level: Application REF: p. 344 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety MULTIPLE RESPONSE 1. Which important teaching point(s) should be included in an educational plan on niacin

prescribed to treat hyperlipidemia? (Select all that apply.) a. Effectiveness of niacin in lowering total cholesterol b. Information on high cholesterol foods and food preparation using unsaturated fats c. Importance of smoking cessation and daily exercise d. Alternative funding resource information because of the high cost of niacin e. Adverse effects to report (e.g., fatigue, anorexia, nausea, malaise, jaundice, muscle aches) ANS: A, B, E

Therapeutic outcomes expected with niacin use include reduction in LDL and total cholesterol levels, reduction in triglyceride levels, and increase in HDL levels. Niacin is used in conjunction with dietary therapy to decrease elevated cholesterol concentrations in hyperlipidemia and to reduce the risks of atherosclerosis leading to coronary heart disease.

Initial adverse effects to expect include nausea, gas, abdominal discomfort, dizziness, faintness, and hypotension. Jaundice, malaise, muscle aches, and anorexia should be reported to the healthcare provider. Although these are healthy lifestyle behaviors, they are not indicated in patient teaching about antilipemic medications. Niacin is not expensive in comparison with other antilipemic medications.

DIF: Cognitive Level: Comprehension REF: p. 349 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 3

2. Which nutritional concept(s) is/are necessary to provide to patients receiving colestipol?

(Select all that apply.) a. Take on an empty stomach to enhance absorption. b. Whole grains, raw fruits, and vegetables will minimize constipation. c. Drink eight to ten 8-ounce glasses of water daily to eliminate dehydration that results from frequent loose stools. d. Report signs of vitamin K deficiency, including bleeding gums, dark tarry stools, and coffee-ground emesis. e. Supplemental fat-soluble vitamins may be necessary.

ANS: B, D, E

Adequate fluid and fiber in the diet will help prevent constipation, as well as additional expected GI adverse effects. High doses of resins may reduce absorption of fat-soluble vitamins; this interaction is not usually significant in normally nourished patients. If these severe symptoms appear, they should be reported to the healthcare provider. Patients who are taking bile acid–sequestering resins may require supplemental fat-soluble vitamin therapy (A, D, E, K). The recommended time of administration is with meals, but this may be modified to avoid interference with absorption of other medications. Constipation is a more likely adverse effect than loose stools.

DIF: Cognitive Level: Comprehension REF: p. 345 | p. 346 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Nutrition 3. Which food(s) should be avoided by a patient with hyperlipidemia? (Select all that apply.) a. Hard cheeses b. Egg whites c. Unsaturated vegetable oils d. Green vegetables e. Liver ANS: A, E

Patients with hyperlipidemia should avoid foods high in cholesterol, such as cheeses and organ meats. Egg whites, unsaturated vegetable oils, and green vegetables do not negatively affect hyperlipidemia.

DIF: Cognitive Level: Comprehension REF: p. 341 OBJ: 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Nutrition 4. Which information will the nurse review when teaching a patient about therapy with statins?

(Select all that apply.) a. Statins are the most potent antilipemic agents available. b. Statins should be taken with food. c. Statins replace dietary therapy for the control of hyperlipidemia. d. Statins cause mild increases in HDL levels. e. Statins are administered in the morning when cholesterol production is high. f. Statins reduce inflammation, platelet aggregation, and plasma viscosity.

ANS: A, B, D, F

Statins are the most potent drugs available for treatment of hyperlipidemia, should be taken with food, may increase HDL levels, and reduce inflammation, platelet aggregation, and plasma viscosity. Statins are used in conjunction with dietary therapy; they do not replace it.

Cholesterol production is highest at night, so statins should be taken at night with food.

DIF: Cognitive Level: Comprehension REF: p. 343 | p. 344 | p. 345 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education 5. Which statement(s) will be included when educating a resident in a long-term care facility on

a prescription for Lovaza? (Select all that apply.) a. Liver function tests should be completed before initiating therapy. b. Available in tablet form. c. Triglyceride levels should increase with use. d. Should be used with caution if the patient has an allergy to fish. e. Does not cause myositis.

ANS: A, D, E

Liver function tests (AST, ALT) should be completed before initiating therapy and every 6 to 8 weeks during the first year of therapy with Lovaza. Lovaza should be used with caution if patients have an allergy or sensitivity to fish. Lovaza may have an advantage over the fibrates and niacin because it does not cause myositis or rhabdomyolysis. Lovaza is not available in tablet form; it is in capsule form. Triglyceride levels should be reduced.

DIF: Cognitive Level: Comprehension REF: p. 338 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 4

6. The nurse is preparing to administer niacin for the first time to a patient being treated for

dyslipidemia. Which assessments must be completed before administering this medication?

(Select all that apply.) a. Blood glucose levels b. Blood pressure c. Heart rate

d. Temperature e. Oxygen saturation ANS: A, B, C

Baseline blood glucose, blood pressure, and heart rate should be determined before initiating niacin therapy. Temperature and oxygen saturation levels are not necessary prior to administering niacin.

DIF: Cognitive Level: Application REF: p. 351 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment

Chapter 22: Drugs Used to Treat Hypertension Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which response is best to a patient who has just begun taking an angiotensin converting

enzyme (ACE) inhibitor calls the nurse and reports feeling very dizzy when standing up and asks if the medication should be discontinued? a. ―Stop taking the medication immediately.‖ b. ―Rise to a sitting or standing position slowly; your symptoms will resolve.‖ c. ―I will schedule you to visit the healthcare provider today.‖ d. ―Cut the pill in half and take a reduced dosage.‖ ANS: B

Dizziness is a common initial adverse effect of this medication, which is usually transient.

The patient should be instructed to rise from a lying position slowly to avoid orthostatic hypotension and avoid falling. Medications should not be stopped immediately unless a serious adverse effect occurs. Because this is a common occurrence with ACE inhibitors, there is no need for a visit to the healthcare provider. A change in dosage will not alter the effect and should not be made without the advice of the primary care provider.

DIF: Cognitive Level: Application REF: p. 366 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety

OBJ: 2

2. Which nursing assessment confirms that the angiotensin II receptor blocker (ARB) that a

patient is taking is effective? a. Weight loss of more than 2 lb/wk. b. LDL cholesterol levels have decreased. c. Urinary output is increased. d. Blood pressure has decreased.

ANS: D

The primary therapeutic outcome expected from angiotensin II receptor antagonists is reduction of blood pressure to within a normal range. Angiotensin II receptor antagonists bind angiotensin II receptor sites in the vascular smooth muscle, brain, heart, kidneys, and adrenal gland. The blood pressure-elevating (vasoconstricting) and sodium-retaining effects of angiotensin II are thus blocked. Weight loss, although advisable for treatment of hypertension, is not affected by ARBs. ARBs do not affect cholesterol levels. Urine output is not affected by ARBs. DIF: Cognitive Level: Application REF: p. 368 OBJ: 2 | 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 3. Which rational explains how propranolol (Inderal) control hypertension? a. Blocks alpha receptors throughout the body. b. Increases the diuretic response in the renal tubules. c. Reduces the sympathetic stimulation in cardiac muscle. d. Inhibits the conversion of angiotensin I to angiotensin II. ANS: C

The beta-adrenergic blocking agents block beta receptor stimulation in the heart, which then inhibits cardiac response to sympathetic nerve stimulation. This results in a decrease in heart rate, cardiac output, and blood pressure. Beta blockers do not affect alpha receptors. Beta blockers do not have a diuretic effect. ACE inhibitors are in the class of drugs that affects angiotensin conversion.

DIF: Cognitive Level: Knowledge REF: p. 363 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 5 CON: Clinical Judgment

4. Which class of antihypertensive agents should be avoided by patients with asthma? a. ACE inhibitors b. Diuretics c. Aldosterone receptor antagonists d. Beta-adrenergic blocking agents ANS: D

Beta-adrenergic blocking agents can cause bronchoconstriction, which will aggravate asthmatic conditions. ACE inhibitors do not affect respiratory function. Diuretics have the effect of improving respiratory function in cases of congestive heart failure. Aldosterone receptor antagonists do not affect respiratory function.

DIF: Cognitive Level: Knowledge REF: p. 364 OBJ: 5 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education 5. Which statement is true about postural hypotension during therapy with direct vasodilators? a. It indicates a therapeutic effect. b. It gradually resolves with continued medication use. c. It is a dose-limiting complication of drug therapy. d. It is a precursor to hypertensive crisis.

ANS: B

Orthostatic hypotension can occur particularly at the initiation of therapy. Patients should be encouraged to change positions slowly. Symptoms generally will resolve as the patient becomes used to the medication. Postural hypotension is not a therapeutic effect and is not a precursor to a hypertensive crisis. Postural hypotension is an adverse effect with vasodilator therapy.

DIF: Cognitive Level: Comprehension REF: p. 362 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 6. Which symptom is avoided when a patient is aware not to suddenly discontinue

beta-adrenergic blockers? a. Postural hypotension b. Edema c. Increased angina d. Confusion ANS: C

Sudden discontinuation of beta-adrenergic therapy has caused an exacerbation of anginal symptoms, resulting in cases of myocardial infarction. Postural hypotension occurs with the onset of treatment. Edema and confusion are not precipitated by cessation of treatment with beta blockers.

DIF: Cognitive Level: Comprehension REF: p. 363 OBJ: 5 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Perfusion | Health Promotion | Safety 7. Which definition describes arterial pressure (MAP)? a. The difference between the systolic and diastolic pressures b. An indicator of the tone of the arterial blood vessel walls c. The average pressure throughout each cycle of the heartbeat d. The product of the cardiac output and the peripheral vascular resistance ANS: C

The MAP is the average pressure throughout each cycle of the heartbeat and is significant because it is the pressure that actually pushes the blood through the circulatory system. The difference between the systolic and diastolic pressures describes the pulse pressure. An indicator of the tone of the arterial blood vessel walls describes the pulse pressure. The product of the cardiac output and the peripheral vascular resistance describes the arterial blood pressure.

DIF: Cognitive Level: Comprehension REF: p. 353 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 8. Which agents are preferred for the initial treatment of hypertension? a. ACE inhibitors and angiotensin receptor antagonists b. Calcium ion agonists and central-acting alpha agonists c. Thiazide diuretics and beta-adrenergic blockers

d. Direct vasodilators and peripherally acting adrenergic antagonists ANS: C

Preferred agents include diuretics and beta-adrenergic blockers. ACE inhibitors, angiotensin receptor antagonists, calcium ion agonists, and central-acting alpha agonists are alternative agents. Direct vasodilators and peripherally acting adrenergic antagonists are adjunctive agents.

DIF: Cognitive Level: Comprehension REF: p. 363 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 4 CON: Clinical Judgment

9. Which priority nursing action should be taken when prior to the administration of a

beta-adrenergic blocker, the nurse notes the patient to have a heart rate of 52 beats/min, peripheral edema, crackles in the bases of the lungs, and mottled skin? a. Administer the medication as ordered. b. Reevaluate the patient in 20 minutes. c. Obtain a serum blood level. d. Withhold the medication and notify the healthcare provider.

ANS: D

These symptoms warrant the nurse‘s withholding the dose and then notifying the healthcare provider. The medication should not be administered if the patient‘s heart rate is low or the patient is experiencing symptoms of heart failure and poor perfusion. The patient should be assessed frequently after the medication is held and the healthcare provider is notified, but action needs to be taken immediately. Therapeutic blood levels for beta-adrenergic medications are not typically measured.

DIF: Cognitive Level: Application REF: p. 363 | p. 364 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety 10. Which symptom displayed by a patient would be most indicative to the nurse to withhold a

recently prescribed beta-adrenergic blocker? a. Dizziness b. Peripheral edema c. Hyperglycemia d. Wheezing ANS: D

Wheezing in a patient taking beta-adrenergic blockers could indicate the adverse effect of bronchial constriction. Dizziness may indicate changes in blood pressure and safety precautions should be taken, but the medication does not have to be stopped. Peripheral edema may indicate cardiovascular problems, but the medication may have been prescribed to help these conditions. It would not warrant stopping the medication. Hyperglycemia may indicate a need for other interventions but would not be a reason to stop the medication.

DIF: Cognitive Level: Application REF: p. 363 | p. 364 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Gas Exchange

11. Which statement by a patient diagnosed with diabetes and prescribed a beta-adrenergic

blocker indicates a need for further teaching? a. ―If I get dizzy, I will stop taking the medication.‖ b. ―I may not have my usual symptoms of low blood sugars.‖ c. ―My dosage may need adjustment if I start taking any NSAIDs.‖ d. ―I will need to be evaluated in a few weeks to see if my dosage is effective.‖ ANS: A

Patients should never stop taking beta-adrenergic blocking agents suddenly because this can result in exacerbation of angina symptoms. Dizziness should resolve with therapy and patients should be taught how to manage this side effect safely. The patient may not experience the usual symptoms of low blood sugar. The dosage of the beta blocker may need to be increased to compensate for the antihypertensive inhibitory effect of nonsteroidal anti-inflammatory drugs (NSAIDs). The patient will need to be evaluated to see if the dosage is effective.

DIF: Cognitive Level: Comprehension REF: p. 363 | p. 364 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Patient Education | Safety | Health Promotion 12. Which adverse effect is associated ACE inhibitors? a. Constipation b. Chronic cough c. Hypokalemia d. Nervousness ANS: B

Chronic cough may develop in as many as one-third of patients receiving ACE inhibitors.

Constipation, hypokalemia, and nervousness are not adverse effects of this medication.

DIF: Cognitive Level: Knowledge REF: p. 366 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety

OBJ: 5

13. Which statement accurately describes the action ACE inhibitors? a. They increase aldosterone secretion. b. They inhibit vasoconstriction. c. They lower heart rate. d. They promote sodium retention.

ANS: B

ACE inhibitors decrease vasoconstriction and aldosterone secretion. ACE inhibitors do not increase aldosterone secretion, lower the heart rate, or promote sodium retention.

DIF: Cognitive Level: Comprehension REF: p. 364 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 5

14. Which common adverse effect of an angiotensin II receptor antagonist will the nurse expect to

assess in a patient?

a. b. c. d.

Bradycardia Headache Hypokalemia Insomnia

ANS: B

Headache is a common adverse effect of angiotensin II receptor antagonists. Bradycardia, hypokalemia, and insomnia are not common adverse effects of angiotensin II receptor antagonists.

DIF: Cognitive Level: Comprehension REF: p. 369 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 15. Which medication lowers blood pressure by directly inhibiting renin? a. Aliskiren (Tekturna) b. Eplerenone (Inspra) c. Diltiazem (Cardizem) d. Reserpine ANS: A

Aliskiren is a renin angiotensin antagonist. Eplerenone blocks the action of aldosterone.

Diltiazem is a calcium channel blocker. Reserpine depletes catecholamines.

DIF: Cognitive Level: Knowledge REF: p. 369 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 5 CON: Clinical Judgment

16. Which response will the nurse provide when a patient asks the nurse how amlodipine

(Norvasc) works to reduce the blood pressure? a. ―It causes blood vessel dilation.‖ b. ―It helps you get rid of fluid.‖ c. ―It helps your heart beat stronger.‖ d. ―It slows your heart rate.‖ ANS: A

Dihydropyridines (amlodipine) are calcium channel blocking medications that work by inhibiting the vasoconstricting effects of calcium to cause vasodilation. Amlodipine does not have a diuretic effect or cause the heart to contract more forcefully. Calcium channel blockers do slow the heart rate; however, the dihydropyridines (amlodipine) have peripheral vasodilating effects.

DIF: Cognitive Level: Comprehension REF: p. 372 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 5

17. Which action will the nurse take when a patient recently prescribed felodipine (Plendil) for

treatment of hypertension is experiencing dizziness when rising to a standing position? a. Encourage the patient to sit down if feeling faint. b. Advise the patient to increase dietary sodium. c. Inform the patient to discontinue the medication.

d. Instruct the patient to monitor weight daily.

ANS: A

If faintness or dizziness occurs, the nurse instructs the patient to sit or lie down and to change positions more slowly. Advising the patient to increase dietary sodium, informing the patient to discontinue the medication, and instructing the patient to monitor weight are not accurate interventions.

DIF: Cognitive Level: Application REF: p. 372 | p. 373 OBJ: 2 | 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety 18. Which physiologic response will the nurse expect to assess in patients taking hydralazine

(Apresoline)? a. Pale skin b. Tachycardia c. Increased urinary output d. Cool extremities ANS: B

With arteriolar smooth muscle relaxation, there is an increase in heart rate. Pale skin, increased urinary output, and cool extremities are not physiologic responses to hydralazine.

DIF: Cognitive Level: Comprehension REF: p. 379 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 19. Which medication is often administered with hydralazine to reduce reflex physiologic

responses to the drug? a. Beta blockers b. Renin inhibitor c. ACE inhibitor d. Angiotensin II receptor blocker ANS: A

Beta blockers are administered with hydralazine to reduce the reflex tachycardia caused by arterial vasodilation. Diuretics may also be administered to promote water and sodium excretion. Renin inhibitors, ACE inhibitors, and angiotensin II receptor blockers are not usually administered to reduce the physiologic effects of hydralazine.

DIF: Cognitive Level: Comprehension REF: p. 378 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 20. Which condition, associated with hypertension, is treated with Hydralazine? a. Stroke b. Diabetes mellitus c. Myocardial infarction d. Renal disease ANS: D

Hydralazine is used to treat hypertension associated with renal disease. Hydralazine is not used to treat hypertension associated with stroke, diabetes mellitus, or myocardial infarction.

DIF: Cognitive Level: Knowledge REF: p. 378 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 5 CON: Clinical Judgment

21. Which number identifies the pulse pressure for a patient whose blood pressure reading is

134/78? a. 212 b. 134 c. 78 d. 56 ANS: D

56 is the difference between the systolic and diastolic pressure and is called the pulse pressure, which is an indicator of the tone of the arterial blood vessel walls. 212 is not the pulse pressure. 134 is the systolic pressure. 78 is the diastolic pressure.

DIF: Cognitive Level: Analysis REF: p. 353 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment 22. Which number represents MAP if blood pressure is 120/70? a. 50 b. 86.66 c. 16.66 d. 70 ANS: B

MAP = ([systolic pressure – diastolic pressure]/3) + diastolic pressure 120 – 70 = 50 50/3 = 16.66 16.66 + 70 = 86.66 DIF: Cognitive Level: Analysis REF: p. 353 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment MULTIPLE RESPONSE 1. Which complication(s) is/are associated with uncontrolled hypertension? (Select all that

apply.) a. Angina b. Stroke c. Hyperglycemia d. Renal failure e. Heart failure ANS: A, B, D, E

Angina, stroke, renal failure, and heart failure are complications associated with uncontrolled hypertension. Hyperglycemia is not a complication associated with uncontrolled hypertension.

DIF: Cognitive Level: Comprehension REF: p. 354 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Patient Education 2. The nurse is finished conducting nutritional education with a patient about the DASH (dietary

approaches to stop hypertension) diet. The patient would like to complete the breakfast menu for tomorrow. Which foods offered for breakfast would be most appropriate for the patient to choose? (Select all that apply.) a. Grapefruit b. Bacon c. Whole milk d. Orange juice e. Eggs f. Oatmeal ANS: A, D, F

The DASH eating plan includes a diet rich in fruits, vegetables, and low-fat dairy and other foods. Grapefruit, orange juice, and oatmeal would be appropriate choices. Bacon, whole milk, and eggs would not be appropriate for a person on the DASH diet.

DIF: Cognitive Level: Application REF: p. 355 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Nutrition

OBJ: 2

3. Which statement(s) concerning the use of antihypertensive therapy for the treatment of

hypertension would be considered true? (Select all that apply.) a. Diuretics are the most commonly prescribed antihypertensive agent. b. Diuretics are not used for older adult patients. c. Diuretics are the most expensive of the antihypertensive agents. d. Diuretics are often prescribed in combination therapy with other antihypertensive agents. e. Loop diuretics are considered potassium sparing.

ANS: A, D

Diuretics are the most commonly prescribed antihypertensive used to treat all classes of hypertension. They are one of the classes of agents that has been shown to reduce cardiovascular morbidity and mortality associated with hypertension. Diuretics are prescribed in combination therapy to potentiate hypotensive activity. More potent diuretics are used for older adult patients. Diuretics are low in cost. Diuretics often cause excretion of potassium, with the exception of potassium-sparing diuretics used in combination with thiazide.

DIF: Cognitive Level: Comprehension REF: p. 356 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 4 | 5 CON: Clinical Judgment

4. Which statement(s) about diuretics is/are true? (Select all that apply.) a. A mechanism of action for the antihypertensive effects of diuretics includes

volume depletion. b. They have been shown to reduce cardiovascular morbidity associated with

hypertension. c. Thiazide diuretics are effective only if renal creatinine clearance is less than 30

mL/min. d. Diuretics are sodium sparing. e. Electrolytes must be evaluated periodically for patients on loop diuretics.

ANS: A, B, E

Diuretics act as hypertensive agents by causing volume depletion, sodium excretion, and vasodilation of peripheral arterioles. Diuretics are often used to reduce cardiovascular morbidity and mortality rates. Potassium must be monitored in patients taking diuretics that are not potassium sparing. When creatinine clearance is higher than 30 mL/min, thiazide diuretics are most effective. Diuretics cause sodium excretion.

DIF: Cognitive Level: Comprehension REF: p. 362 | p. 363 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 5. The nurse is preparing to assess blood pressure on a patient who has had two prior readings of

160/100. Physician‘s notes from a prior visit indicate that the patient is suspected to have hypertension. Which action(s) will be taken when reassessing this patient for hypertension?

(Select all that apply.) a. Instruct patient to sit on the exam table. b. Choose a cuff encircling at least 80% of the arm. c. Support patient‘s arm at heart level. d. Encourage patient to sit quietly for 5 minutes before assessing blood pressure. e. Instruct the patient that one more increased reading is required before hypertension is diagnosed.

ANS: B, C, D

An appropriately sized cuff bladder encircles at least 80% of the arm and is required for accuracy. The arm is supported at heart level. The individual should be seated quietly for at least 5 minutes in a chair with feet on the floor. Sitting on an exam table is not preferred. Feet should be on the floor. An elevated reading on two or more separate occasions after initial screening is considered hypertension.

DIF: Cognitive Level: Application REF: p. 354 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety | Health Promotion

Chapter 23: Drugs Used to Treat Dysrhythmias Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which explanation accurately explains the action of amiodarone (Cordarone)? a. It acts as a myocardial depressant by inhibiting sodium ion movement. b. It prolongs the duration of the electrical stimulation on cells and the refractory time

between electrical impulses.

c. It acts as a beta-adrenergic agent. d. It slows the rate of electrical conduction and prolongs the time between

contractions.

ANS: D

Class I antidysrhythmic drugs act as a myocardial depressant by inhibiting sodium ion movement. Class II antidysrhythmic drugs act as beta-adrenergic agents. Class III agents slow the rate of electrical conduction and prolong the time between contractions. Class IV antidysrhythmic drugs prolong the duration of the electrical stimulation on cells and the refractory time between electrical impulses.

DIF: Cognitive Level: Comprehension REF: p. 383 | p. 390 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 2. How many milligrams of lidocaine will the nurse administer via intravenous (IV) bolus to a

30-year-old patient with ventricular tachycardia who weighs 75 kg after a myocardial infarction? a. 10 b. 25 c. 50 d. 75 ANS: D

The initial lidocaine bolus is 1 to 1.5 mg/kg, decreased by half in older adults, patients with hepatic disease, and patients with heart failure. Doses of 10, 25, and 50 mg are too low for a patient of this weight.

DIF: Cognitive Level: Application REF: p. 386 | p. 387 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment 3. Which instruction should be provided to a patient taking amiodarone (Cordarone) for

hypertrophic cardiomyopathy that begins to complain of dizziness? a. Discontinue the medication immediately. b. Decrease the medication dosage for 1 week, and then resume the original order. c. Change positions slowly. d. Increase the dosage per healthcare provider directions.

ANS: C

Many adverse effects are dose related and resolve with reducing the dosage or discontinuing therapy. Patients should be taught to rise slowly from a supine or sitting position and sit or lie down if feeling faint. Medication should be discontinued only for serious adverse effects and with the consent of the healthcare provider. Changes in dose should be done only with the consent of the healthcare provider. Increasing the dose will likely increase the symptoms.

DIF: Cognitive Level: Application REF: p. 391 OBJ: 3 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety

4. Which possible effect should the nurse assess for in a patient who is started on phenytoin

(Dilantin), who is also taking amiodarone (Cordarone)? a. Central nervous system depression and sedation b. Decrease in effectiveness of phenytoin c. Respiratory depression d. Increase in serum phenytoin levels ANS: D

Elevation of phenytoin serum levels (200% to 300%) is observed over several weeks. The dosage of phenytoin must be gradually reduced based on patient response. The combination of phenytoin and amiodarone does not produce sedation and depression, decrease the effectiveness of either drug, or produce respiratory depression.

DIF: Cognitive Level: Comprehension REF: p. 391 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 3 CON: Clinical Judgment | Safety

5. Which lidocaine preparation is appropriate for the treatment of cardiac dysrhythmias? a. 0.1% lidocaine with preservative b. 2% lidocaine for topical use c. Lidocaine patch d. Injectable lidocaine without preservative ANS: D

Lidocaine for IV use is different from lidocaine used as a local anesthetic. The label for lidocaine for IV use should read ―lidocaine for dysrhythmias‖ or ―lidocaine without preservatives.‖ The 0.1% lidocaine, 2% lidocaine for topical use, and lidocaine patch are for topical anesthetic use.

DIF: Cognitive Level: Comprehension REF: p. 387 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 CON: Clinical Judgment

6. Which complication should be closely observed for in a patient on neuromuscular blocking

agents and lidocaine? a. Hyperkalemia b. Respiratory depression c. Neurotoxicity d. Seizures ANS: B

Lidocaine, when administered with neuromuscular blocking agents, may cause respiratory depression. Ventilator-dependent patients may require additional time to be weaned when on these categories of medications. Hyperkalemia, neurotoxicity, and seizures are not adverse effects of therapy with these two drugs.

DIF: Cognitive Level: Comprehension REF: p. 387 OBJ: 3 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Gas Exchange 7. Which statement is true regarding the antidysrhythmic agent adenosine (Adenocard)? a. It is synthesized from petroleum products.

b. It is created through recombinant DNA. c. It is extracted from plants. d. It is a naturally occurring chemical in the body.

ANS: D

Adenosine is a naturally occurring chemical found in every cell within the body. Adenosine is not synthesized from petroleum products, is not created through recombinant DNA, and is not extracted from plants.

DIF: Cognitive Level: Knowledge REF: p. 394 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 CON: Clinical Judgment

8. Which condition would be a contraindication for amiodarone administration? a. Pulmonary edema b. Severe sinus node dysfunction causing bradycardia c. Atrial fibrillation d. Premature ventricular contractions (PVCs) ANS: B

Amiodarone is contraindicated for patients with severe sinus node dysfunction that causes sinus bradycardia, with second and third degree AV block, and when episodes of bradycardia have caused syncope (except in the presence of a pacemaker). Pulmonary edema is not a contraindication for amiodarone. Atrial fibrillation is an indication for the use of amiodarone.

Premature ventricular contractions are not a contraindication for amiodarone, but the medication is not indicated for the treatment of PVCs. DIF: Cognitive Level: Comprehension REF: p. 390 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Perfusion

OBJ: 1 | 4

9. Which common adverse effect is a patient that was recently prescribed quinidine at the highest

risk to exhibit? a. Chills b. Diarrhea c. Nausea d. Rash ANS: B

Diarrhea is common during initiation of quinidine therapy. Chills, nausea, and rash are not common adverse effects that occur during initiation of quinidine therapy.

DIF: Cognitive Level: Knowledge REF: p. 386 | p. 387 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 10. Which symptom will the nurse encourage the patient taking flecainide to report to the

healthcare provider? a. Headache b. Dizziness c. Constipation

d. Weight gain ANS: D

Flecainide may induce or aggravate preexisting heart failure. Weight gain is a symptom of fluid retention; the patient should be instructed to contact the healthcare provider for further evaluation. Headache and constipation are not typical adverse effects. Dizziness is usually mild and tends to resolve with continued therapy.

DIF: Cognitive Level: Comprehension REF: p. 388 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Patient Education | Safety 11. A patient is admitted to the acute care telemetry unit with a diagnosis of atrial fibrillation. The

physician orders dofetilide (Tikosyn). Which action will the nurse take before initiating this medication? a. Hold anticoagulant medications. b. Remove ECG leads. c. Assess potassium level. d. Ensure Q–Tc interval is more than 440 to 500 msec.

ANS: C

Hypokalemia must be corrected before initiation of dofetilide therapy. Before dofetilide (Tikosyn) is initiated on patients with atrial fibrillation, anticoagulation must occur. Patients with atrial fibrillation must be admitted to a unit with continuous ECG monitoring available.

The Q–Tc interval must be assessed; if it is more than 440 to 500 msec, dofetilide is contraindicated.

DIF: Cognitive Level: Application REF: p. 392 | p. 393 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 12. A patient is admitted to the telemetry unit with a diagnosis of cardiovascular disease. When

performing the initial assessment, the nurse records blood pressure in the left arm of 142/84, blood pressure in the right arm of 138/80, temperature of 98.8F, and radial pulse of 80 that is weak and irregular. Which assessment information warrants physician notification? a. Both blood pressure and pulse b. Blood pressure only c. Pulse only d. Both blood pressure and temperature ANS: C

Irregular pulse rate and rhythm should be reported. A systolic pressure variance of 5 to 10 mm Hg is normal; readings reflecting a variance of more than 10 mm Hg should be reported for further evaluation. Temperature is within normal limits.

DIF: Cognitive Level: Application REF: p. 385 OBJ: 2 | 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety MULTIPLE RESPONSE

1. Which baseline nursing assessment(s) should be the priority(ies) when assessing a patient who

was recently admitted to the emergency department with dysrhythmias and shortness of breath? (Select all that apply.) a. ECG monitoring b. Medication history c. Oxygen saturation d. Presence of chest pain, dyspnea, and fatigue e. Mental status f. Sleep pattern ANS: A, B, C, D, E

Baseline nursing assessment of patients with dysrhythmias includes ECG monitoring, medication and medical histories, oxygen saturation, observation for the six cardinal signs of cardiovascular disease, and neurologic assessment. Sleep pattern history is not a priority for this patient.

DIF: Cognitive Level: Application REF: p. 386 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 2. Which consideration(s) should the nurse take into account before administration of adenosine

to a patient with supraventricular tachycardia? (Select all that apply.) a. Constant ECG monitoring is necessary. b. Initial recommended dosage is 12 mg IV bolus. c. Rapid IV bolus administration is recommended. d. Saline flush following bolus is necessary. e. Long half-life of adenosine may prolong adverse medication effects.

ANS: A, C, D

Continuous cardiac monitoring is required when administering any IV medications to treat dysrhythmias. Because of the short half-life of adenosine, the IV bolus should be administered rapidly. The initial dosage of adenosine is rapid IV bolus of 6 mg followed by a saline flush.

Adenosine has a short half-life.

DIF: Cognitive Level: Comprehension REF: p. 394 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 | 2 CON: Clinical Judgment | Safety

3. Which consideration(s) should the nurse take into account before administration of a lidocaine

infusion? (Select all that apply.) a. Lidocaine with preservatives should be used. b. Dextrose 5% is the solution to mix with lidocaine. c. Therapeutic blood levels should be 1 to 5 mg/L. d. The rate of administration is 1 to 4 mg/min. e. Monitor for changes in neurologic status.

ANS: B, C, D, E

Lidocaine for infusion should be mixed with dextrose 5% solution. Lidocaine administration rate should be 1 to 4 mg/min. Additional nursing considerations include monitoring of therapeutic blood levels (1 to 5 mg/L) and observing for adverse effects to report to the healthcare provider. Lidocaine for IV use for dysrhythmias is different from lidocaine used as a local anesthetic. For use with dysrhythmias, check the label carefully to be certain it says ―lidocaine for dysrhythmias‖ or ―lidocaine without preservatives.‖ DIF: Cognitive Level: Application REF: p. 387 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 | 2 CON: Clinical Judgment | Safety

4. Which assessments will be completed before administering procainamide hydrochloride for

the first time to a patient newly diagnosed with atrial fibrillation? (Select all that apply.) a. Cardiac rhythm b. Blood pressure c. Oxygen saturation d. Blood glucose levels e. Liver function tests ANS: A, B, C

The nurse should assess cardiac rhythm, vital signs, and oxygen saturation to use as a baseline for subsequent evaluation to response. Blood glucose levels and liver function tests are not essential assessments prior to providing procainamide hydrochloride for the first time.

DIF: Cognitive Level: Application REF: p. 387 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety

Chapter 24: Drugs Used to Treat Angina Pectoris Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which medication combinations may be beneficial in treating angina pectoris? a. Antidysrhythmics and platelet active agents b. ACE inhibitors and statins c. Vasoconstrictors and diuretics d. Analgesics and thrombolytics ANS: B

ACE inhibitors and statins are often combined to treat angina pectoris. Antidysrhythmics and platelet active agents are not used in combination to treat angina because angina does not typically result in rhythm disturbances. Vasoconstrictors would exacerbate angina and are not used with diuretics. Analgesics and thrombolytics are not used in combination to treat angina because angina is not caused by a clot, so thrombolytics are not necessary.

DIF: Cognitive Level: Knowledge REF: p. 398 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 2 | 3 CON: Clinical Judgment

2. Which indication is primary for using a HMG-CoA reductase inhibitor for a patient diagnosed

with angina pectoris and an elevated LDL cholesterol level? a. Reduce coronary vessel spasm. b. Simplify oxygen requirements of the cardiac cells. c. Lower cholesterol levels. d. Dilate the coronary arteries.

ANS: C

HMG-CoA reductase inhibitor, a statin, has become standard therapy to be used with elevated cholesterol levels. This medication prevents added atherosclerotic vessel buildup and further narrowing of the coronary arteries. Statins do not affect vascular spasms or oxygen requirements of cells. Statins do not dilate coronary arteries.

DIF: Cognitive Level: Comprehension REF: p. 398 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 3. Which information will the nurse give when advising a patient on what to do to avoid the

development of tolerance to nitroglycerin? a. Use the sublingual form only. b. Administer subsequent doses parenterally. c. Allow for a daily 8- to 12-hour nitrate free period. d. Store the drug in a dark container, free from light and moisture.

ANS: C

An 8- to 12-hour nitrate free period will eliminate the development of tolerance to nitroglycerin. Route of administration and medication storage methods do not affect tolerance.

DIF: Cognitive Level: Comprehension REF: p. 401 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety | Health Promotion 4. Which instruction will the nurse include for a patient prescribed sublingual nitrate PRN for

angina? a. Take a dose routinely at bedtime. b. Place the tablet under the tongue and swallow immediately. c. Take one tablet and then seek medical attention if the pain is not relieved within 5 minutes. d. Take one tablet every 2 to 3 minutes until relief is obtained.

ANS: C

The patient should seek medical attention if chest pain is not relieved by one tablet within 5 minutes. Tablets should continue to be taken every 5 minutes, for a total of three tablets in 15 minutes if pain is not relieved. Nitrates are taken at the indication of pain. Sublingual nitrates are not swallowed.

DIF: Cognitive Level: Application REF: p. 401 OBJ: 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety | Health Promotion

5. Which time period indicates how frequently nitroglycerin tablets are discarded and

prescriptions refilled? a. Monthly b. Every 3 months c. Every 6 months d. Yearly ANS: C

Every 6 months, the nitroglycerin prescription should be refilled and the old tablets safely discarded. Nitroglycerin has a longer shelf life than 1 or 3 months but does not have a shelf life as long as 1 year.

DIF: Cognitive Level: Knowledge REF: p. 401 OBJ: 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education 6. When are sustained-release nitroglycerin tablets administered? a. Once a day b. At bedtime c. When symptoms of acute angina appear d. Every 8 to 12 hours ANS: D

Sustained-release nitroglycerin tablets are usually taken on an empty stomach every 8 to 12 hours. If gastritis develops, it may be necessary to take these tablets with food. To be effective, sustained-release nitroglycerin must be taken more often. Sustained-release nitroglycerin is taken to prevent angina; waiting until symptoms occur decreases its effectiveness.

DIF: Cognitive Level: Knowledge REF: p. 401 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety

OBJ: 3

7. Which instruction will the nurse include when teaching a patient about the administration of

translingual nitroglycerin spray? a. Shake the container to disperse the medication evenly. b. Inhale the medication slowly over 1 to 2 minutes. c. Administer the medication under the tongue. d. Close the mouth and ―swallow‖ the spray.

ANS: C

Translingual nitroglycerin spray should be sprayed onto or under the tongue. The container should not be shaken because the bubbles formed may slow the release of the medication. The spray should not be inhaled or swallowed. Shaking the container can cause bubbles that will slow the release of nitroglycerin. The dose should not be inhaled or swallowed.

DIF: Cognitive Level: Comprehension REF: p. 401 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 3

8. Which statement is true regarding the pain associated with angina? a. It does not subside until treatment is initiated. b. It is highly variable in intensity and location. c. It typically subsides after 1 to 3 minutes. d. It is directly related to the degree of myocardial damage.

ANS: B

The presentation of angina pectoris is highly variable. The sensation of discomfort may be described as squeezing, tightness, choking, pressure, burning, or heaviness. Pain or discomfort may radiate to the neck, lower jaw, shoulder, and arm. Attacks can last from 30 seconds to 30 minutes. Anginal pain usually does subside with rest. Sustained pain is usually indicative of a myocardial infarction. Although angina pain may subside in this way, in general, it is highly variable in how it is manifested. Anginal pain may or may not correlate with the amount of myocardial damage.

DIF: Cognitive Level: Comprehension REF: p. 397 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Pain 9. Which information explains how beta-adrenergic blocking agents reduce myocardial oxygen

demand? a. Inhibit the stimulation of norepinephrine and epinephrine. b. Increase the production of dopamine and acetylcholine. c. Delay the destruction of acetylcholinesterase and cholinesterase. d. Enhance the sensitivity of alpha receptors and beta receptors.

ANS: A

Beta-adrenergic blocking agents prevent the stimulation of epinephrine and norepinephrine, which normally increase heart rate. Dopamine and acetylcholine are not beta-adrenergic neurotransmitters. Beta blockers do not delay the destruction of these enzymes. Beta blockers do not enhance the sensitivity of alpha adrenergic and beta receptor sites.

DIF: Cognitive Level: Comprehension REF: p. 404 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Perfusion 10. Which instruction will the nurse provide when teaching a patient about nitroglycerin prior to

discharge to home? a. ―Report any headaches following self-administration to your healthcare provider.‖ b. ―Carry the medication in a pocket directly next to the body.‖ c. ―Carry the medication with you at all times.‖ d. ―Store nitroglycerin in a clear glass container with a tight lid.‖ ANS: C

Nonhospitalized patients should carry nitroglycerin at all times. Headache is an expected adverse effect. Heat causes the medication to deteriorate, so being carried next to the body would cause it to become ineffective. Tablets are degraded by sunlight.

DIF: Cognitive Level: Application REF: p. 401 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 3

CON: Clinical Judgment | Patient Education | Safety | Health Promotion 11. Which risk is minimized when the smallest dose of nitroglycerin is used to provide

satisfactory results? a. Allergy b. Dependence c. Tolerance d. Nausea ANS: C

Tolerance to nitrates can develop rapidly, particularly if large doses are administered frequently. Allergy to nitrates is highly unlikely. Increasing dosages and frequency of nitrate use is more likely to reflect deterioration of cardiac function than dependence on the medication. Nausea is not a common adverse effect of nitrate treatment.

DIF: Cognitive Level: Comprehension REF: p. 401 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 3

12. Which type of angina is precipitated by physical exertion and is relieved by rest? a. Chronic stable b. Nocturnal c. Unstable d. Variant ANS: A

Chronic stable angina is precipitated by physical exertion or stress, lasts only a few minutes, and is relieved by rest or nitroglycerin. Nocturnal is not a designated classification. Unstable angina is unpredictable. Variant angina occurs at rest.

DIF: Cognitive Level: Knowledge REF: p. 397 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Pain 13. Which rationale is behind administering calcium channel blockers to patients with angina? a. They decrease heart rate. b. They dilate blood vessels. c. They increase cardiac contractility. d. They promote fluid excretion.

ANS: B

By inhibiting smooth muscle contraction, the calcium channel blockers dilate blood vessels and decrease resistance to blood flow. Dilation of peripheral vessels reduces the workload of the heart. Calcium channel blockers are not given to decrease heart rate in patients with angina. Calcium channel blockers do not increase cardiac contractility or promote fluid excretion.

DIF: Cognitive Level: Comprehension REF: p. 404 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Perfusion

OBJ: 3

14. Which action by the nurse is most accurate when administering nitroglycerin ointment to a

patient? a. Spread the ointment on the patient‘s legs in a thin, uniform layer. b. Cover the patch with a clear plastic wrap. c. Rub the ointment into the skin in a circular motion. d. Shave the skin prior to application.

ANS: B

Covering the area where the patch is placed with a clear plastic wrap and taping it in place is appropriate. The ointment is not applied to the lower extremities, including the legs. The ointment should not be rubbed into the skin. Shaving is not recommended prior to application because of possible skin irritation.

DIF: Cognitive Level: Application REF: p. 402 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Health Promotion | Safety

OBJ: 3

15. Which response will the nurse provide when a patient complains of a headache when using

sublingual nitroglycerin? a. ―This is a common adverse effect that can be managed with acetaminophen.‖ b. ―Discontinue taking this medication.‖ c. ―Try taking this medication at night to minimize the possibility of headaches.‖ d. ―Lie down after using nitroglycerin to avoid a headache.‖ ANS: A

The most common adverse effect of nitrate therapy is headache. Analgesics, such as acetaminophen, may be used if needed. The medication should not be discontinued. When administered sublingually, this medication is taken as needed for chest pain. Lying down will not prevent the occurrence of a headache.

DIF: Cognitive Level: Application REF: p. 403 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Pain

OBJ: 3

16. Which statement about ranolazine (Ranexa), a fatty oxidase enzyme inhibitor, is true? a. It causes coronary artery vasodilation. b. It causes no gastrointestinal (GI) side effects. c. It causes Q–T interval prolongation. d. It elevates LDL levels.

ANS: C

Baseline and follow-up ECGs should be obtained to evaluate the effects on the patient‘s Q–T incorrect interval. Increased coronary artery vasodilation is not an effect of this medication.

This medication causes GI side effects such as abdominal pain. This medication does not elevate LDL levels.

DIF: Cognitive Level: Comprehension REF: p. 406 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 3 CON: Clinical Judgment

17. Which information will the nurse document when obtaining information for angina therapy in

regard to the central nervous system (CNS) on a patient diagnosed with angina pectoris? a. History of smoking b. Diet c. Anxiety level d. Heart rate ANS: C

Anxiety level is a component of assessing the CNS. History of smoking is included when assessing the cardiovascular system. Diet is included when assessing nutritional history. Heart rate is included when assessing the cardiovascular system.

DIF: Cognitive Level: Application REF: p. 390 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment MULTIPLE RESPONSE 1. Which therapy(ies) is/are used in the treatment of angina pectoris? (Select all that apply.) a. ECG b. Coronary artery bypass c. Coronary angioplasty d. Avoidance of caffeine and emotional stress e. Use of nitrates ANS: B, C, D, E

Coronary artery bypass and coronary angioplasty may be standard treatment of angina pectoris, pending medical evaluation. Avoiding caffeine and emotional stress and use of nitrates is standard treatment of angina pectoris. An ECG is not a procedure for the treatment of angina.

DIF: Cognitive Level: Knowledge REF: p. 397 | p. 400 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment 2. Which lifestyle modification(s) will the nurse include when educating the patient with angina

pectoris? (Select all that apply.) a. Weight-reduction therapy b. Low-potassium diet c. Smoking cessation d. Stress management e. Independent exercise ANS: A, C, D

Although medications can control angina attacks, lifestyle changes such as maintaining an ideal weight are important in managing the disease. Smoking cessation is a vital component to include when educating the patient with angina pectoris. Limiting potassium is not a recommendation for treatment of angina pectoris. The patient should always consult the healthcare provider before participating in any exercise regimen.

DIF: Cognitive Level: Comprehension REF: p. 400 OBJ: 1 | 2 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety | Health Promotion 3. Which information will the nurse include in discharge teaching for patients on nitrate therapy?

(Select all that apply.) a. Increase caffeine in diet b. Relaxation techniques c. Proper storage of medications d. Pain assessment e. Isometric exercise program ANS: B, C, D

Lifestyle modifications such as relaxation techniques are essential for many individuals with angina. Nitrates should be stored in dark, airtight containers. Pain assessment and rating is an important part of nitrate therapy. Increasing caffeine in the diet should be discouraged.

Participation in a regular, moderate exercise program is essential, but exercise should not be strenuous or isometric in patients with angina.

DIF: Cognitive Level: Comprehension REF: p. 400 | p. 403 OBJ: 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Health Promotion 4. Which information will the nurse include in the teaching plan for a patient with angina who is

prescribed a beta-adrenergic blocking agent? (Select all that apply.) a. Goals include reduced frequency of attacks, reduced nitrate use, and improved exercise tolerance. b. Only some beta blockers are effective in treating angina pectoris. c. Comorbidities, such as diabetes or COPD, influence the product selection of beta blockers to treat angina. d. Cardioselective agents minimize pulmonary and peripheral vascular adverse effects. e. Stress exercise is an effective way to determine the most appropriate dosage. f. Acebutolol, atenolol, and metoprolol must be taken in divided doses to be effective in treating angina.

ANS: A, C, D, E

Beta blockers are used to reduce the frequency of attacks, reduce nitrate use, and improve exercise tolerance. Comorbidities influence product selection in the angina patient.

Cardioselective agents have greater affinity for beta-1 adrenergic receptors (cardiac) than beta-2 adrenergic receptors (bronchi, peripheral blood vessels), thereby reducing the possible pulmonary and vascular adverse effects. Stress exercise is an effective way to determine the most appropriate dosage. All beta blockers are effective in treating angina pectoris. Divided doses are not necessary to provide effective control of angina.

DIF: Cognitive Level: Comprehension REF: p. 404 | p. 405 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Patient Education | Health Promotion

5. Which laboratory study result(s) should the nurse ensure is/are available before initiating a

new order for ranolazine (Ranexa)? (Select all that apply.) a. Electrocardiography b. BUN c. Creatinine d. Electrolyte levels e. CBC ANS: A, B, C, D, E

Premedication assessment for ranolazine (Ranexa) includes assessment of results of electrocardiography; renal function tests such as BUN, serum creatinine, and electrolyte levels; and CBC. These results will serve as a baseline for future comparison.

DIF: Cognitive Level: Comprehension REF: p. 406 | p. 407 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 6. Which intervention(s) will the nurse perform when assessing peripheral perfusion while

performing a head-to-toe assessment on a resident in a long-term care facility with a history of angina pectoris? (Select all that apply.) a. Count heart rate and describe rhythm. b. Note any loss of hair on lower legs. c. Auscultate blood pressure. d. Check pedal pulses. e. Assess pupil reaction.

ANS: B, D

Peripheral perfusion assessment includes noting loss of hair on lower legs, denoting decreased circulation. When assessing peripheral perfusion, the pedal pulses in the lower extremities are assessed in conjunction with skin color and temperature. Heart rate and rhythm are components of assessment of the cardiovascular system but not associated with peripheral tissue perfusion. Pupil reaction is considered a neurologic assessment.

DIF: Cognitive Level: Application REF: p. 399 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment | Nursing Process Step: Implementation CON: Clinical Judgment | Perfusion

Chapter 25: Drugs Used to Treat Peripheral Vascular Disease Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which action will the nurse take first when assessing a patient‘s leg for peripheral vascular

disease (PVD) and unable to palpate the pedal pulse in either foot? a. Contact the healthcare provider for further orders. b. Request x-ray studies of the lower extremities. c. Request that the patient lie flat. d. Obtain a Doppler ultrasound device for auscultation.

ANS: D

The Doppler ultrasound device may aid in determining peripheral blood flow. This is not a sufficient cause to notify the healthcare provider and does not warrant radiologic examination without further assessment. Positioning will not affect the assessment of pedal pulses.

DIF: Cognitive Level: Application REF: p. 411 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Perfusion

OBJ: 1

2. Which statement describes the action of pentoxifylline (Trental)? a. Vasodilates the peripheral arteries. b. Potentiates the blood-clotting mechanism. c. Increases erythrocyte flexibility. d. Increases blood viscosity.

ANS: C

Pentoxifylline enhances red blood cell (erythrocyte) flexibility, which reduces blood viscosity.

This allows for more blood to perfuse into the tissues. Muscle tissues become better oxygenated and intermittent claudication is reduced. Pentoxifylline does not cause vasodilation. Pentoxifylline acts to decrease clotting and decreases blood viscosity.

DIF: Cognitive Level: Comprehension REF: p. 410 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Perfusion | Clotting

OBJ: 3

3. Which assessment verifies increased blood perfusion to the lower extremities? a. Toes cool to the touch b. Decreased sensation below the knees c. Increased amplitude of pedal pulses d. Paleness of the foot ANS: C

The pressure of blood as it is pushed against an artery is detected as a pulse. Increased pulse amplitude indicates increased blood flow. Coolness and decreased sensation usually correlate with decreased blood perfusion. Paleness or blanching does not indicate increased blood perfusion.

DIF: Cognitive Level: Comprehension REF: p. 411 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Perfusion | Clotting 4. Which patient statement indicates to the nurse that the patient has a good understanding of

PVD? a. ―Symptoms are warning signs of the increased potential to develop diseases.‖ b. ―Pharmacologic treatments can reverse the disease process.‖ c. ―Surgical interventions will cure the disease.‖ d. ―Controlling contributing factors may affect the progression of the disease.‖ ANS: D

Patients must be taught the interrelationships between the PVD and other related diseases that they may have, such as diabetes, hypertension, angina, and hyperlipidemia. Control or lack of control of the contributing factors of these related diseases will significantly affect the progression of the PVD. PVD is usually a development that is related to other diseases already present in the body. PVD can be controlled but not cured or completely reversed. Surgical interventions will not cure the disease, although it may somewhat control the vascular damage.

DIF: Cognitive Level: Comprehension REF: p. 409 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Communication 5. Which medication will alert the nurse to monitor closely for adverse effects when assessing a

client recently prescribed pentoxifylline (Trental)? a. Antilipemic b. Antihypertensive c. Antibiotic d. Antipsychotic ANS: B

Patients receiving pentoxifylline frequently display a small reduction in systemic blood pressure. An antihypertensive medication may potentiate this effect. Patients must be monitored for hypotension, and therapy may have to be reduced to minimize adverse effects.

Pentoxifylline does not interact with antilipemic, antibiotic, or antipsychotic agents.

DIF: Cognitive Level: Comprehension REF: p. 413 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 3 CON: Clinical Judgment | Safety

6. Which statement by patient that has recently been prescribed cilostazol (Pletal) indicates this

medication is effective? a. ―I have less leg cramping when I walk.‖ b. ―My pulse rate is more regular.‖ c. ―I have had fewer episodes of angina.‖ d. ―My blood pressure has decreased.‖ ANS: A

The primary therapeutic outcome expected from cilostazol is improved tissue perfusion, with a reduced frequency of pain, improved tolerance to exercise, and improved peripheral pulses.

A more regular pulse, decreased episodes of angina, and decreased blood pressure are not expected outcomes of cilostazol administration.

DIF: Cognitive Level: Comprehension REF: p. 413 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Perfusion 7. The nurse has completed teaching to a patient recently prescribed cilostazol (Pletal). Which

statement by the patient indicates a need for further teaching? a. ―I will sit down if I feel lightheaded or faint.‖ b. ―Because this medication helps my circulation, I will try to quit smoking.‖

c. ―Grapefruit juice will increase the effects of this medication.‖ d. ―Diarrhea may occur but likely will stop with continued therapy.‖ ANS: C

Grapefruit juice inhibits the metabolism of cilostazol and would decrease the effects of the medication. Sitting down when feeling lightheaded is an appropriate patient action. Smoking may limit the benefits of taking cilostazol. Diarrhea is usually mild and tends to resolve with continued therapy.

DIF: Cognitive Level: Comprehension REF: p. 414 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Communication | Patient Education

OBJ: 4

8. Which action will the nurse take when providing foot care to a patient diagnosed with

peripheral vascular disease? a. Assist the patient to a supine position. b. Keep feet moistened with lotion. c. Trim toenails daily. d. Change socks daily.

ANS: D

To avoid skin breakdown, the patient should change socks daily. Blood flow is improved when the head of the bed is elevated 12 to 16 inches. Supine position is contraindicated. Feet should be kept dry on a person with peripheral vascular disease. Toenails should be trimmed when necessary, preferably by a podiatrist.

DIF: Cognitive Level: Application REF: p. 412 OBJ: 2 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Skin Integrity MULTIPLE RESPONSE 1. Which assessments are included in the baseline assessment of PVD? (Select all that apply.) a. History of heart disease b. Smoking and dietary habits c. Current medications d. Weight e. Limb pain f. Mental status ANS: A, B, C, D, E

Age, gender, race, family history of incidence of symptoms of PVD, hypertension, and cardiac disease indicate risk factors for developing PVD. Smoking causes vasoconstriction, and dietary habits can cause atherosclerosis, predisposing the patient to PVD. Current medications are essential to know in order to prescribe a pharmacologic agent without exposing the patient to possible drug interactions. Weight may factor into calculations for prescribing medications to treat PVD. Limb pain is a symptom of PVD and may allow the healthcare provider to assess the extent of existing disease. Mental status is not included in the baseline assessment of PVD.

DIF: Cognitive Level: Comprehension REF: p. 411 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Perfusion | Clotting 2. The nurse is preparing a teaching plan for a patient with Raynaud‘s disease who is soon to be

discharged. Which information will be included to improve circulation and prevent complications when preparing a teaching plan for a patient diagnosed with Raynaud‘s disease? (Select all that apply.) a. Begin a daily exercise program. b. Keep hands and feet warm. c. Surgery is often the most effective treatment. d. Elevate the lower extremities when reclining. e. Smoking cessation will improve outcomes.

ANS: A, B, E

Daily exercise, maintenance of extremity warmth, and smoking cessation promote circulation and prevent complications. Surgery is not an effective treatment for Raynaud‘s disease.

Patients with Raynaud‘s disease should not elevate their extremities when reclining.

DIF: Cognitive Level: Comprehension REF: p. 410 | p. 412 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Communication | Patient Education 3. What information will the nurse include in the discharge teaching plan for a patient diagnosed

with PVD? (Select all that apply.) a. Intermittent cold applications to the extremities b. Heat therapy c. Stress reduction techniques d. An exercise program e. Bed positioning techniques ANS: C, D, E

Diseases such as diabetes, hypertension, angina, and hyperlipidemia are interrelated with PVD. Stress reduction techniques will assist patients in reducing blood pressure, smoking, and overeating. A daily exercise program can significantly improve collateral circulation. Bed positioning techniques, such as elevating the bed 12 to 16 inches, improve blood flow to the periphery. Intermittent cold applications to the extremities and heat therapy will not benefit the patient with PVD. DIF: Cognitive Level: Comprehension REF: p. 411 | p. 412| p. 413 OBJ: 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Communication | Patient Education 4. Which steps are necessary in the assessment of the patient preparing for treatment PVD with

pentoxifylline (Trental)? (Select all that apply.) a. Check for intolerance to caffeine. b. Obtain baseline data on pain that may be present. c. Obtain test results for PT and aPTT.

d. Perform baseline gastrointestinal assessment to determine if the patient has nausea,

vomiting, or dyspepsia. e. Ask specifically if the patient has any cardiac symptoms or dizziness. f. Schedule the patient for an exercise stress test.

ANS: A, B, D, E

Before beginning therapy with pentoxifylline, the nurse should determine intolerance to caffeine. To evaluate therapeutic effects of prescribed medications, a baseline is needed against which to compare future assessments. Before beginning therapy with pentoxifylline, the nurse should determine baseline gastrointestinal symptoms and assess for cardiac symptoms, pain, and dizziness. Bleeding times do not apply to therapy with this drug.

Exercise stress testing is not part of the premedication assessment.

DIF: Cognitive Level: Comprehension REF: p. 411 | p. 412| p. 413 OBJ: 1 | 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 5. Which action(s) will the nurse implement when providing care to a resident of a long-term

care facility diagnosed with PVD? (Select all that apply.) a. Initiate elevation of lower extremities. b. Implement pain management as ordered. c. Assess skin temperature. d. Vigorously dry feet after washing. e. Palpate pedal pulses.

ANS: B, C, E

Pain management, assessment of skin temperature, and palpation of pedal pulses are indicated with the care of a patient with PVD. The nurse needs to check with the healthcare provider before initiating elevation of the extremities. It is contraindicated in patients with arterial insufficiency. After bathing, feet should be gently dried. Vigorous rubbing is contraindicated.

DIF: Cognitive Level: Application REF: p. 411 | p. 412| p. 413 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Perfusion | Clotting | Safety

Chapter 26: Drugs Used to Treat Thromboembolic Disorders Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. A trauma patient arrives in the emergency department via EMS. He is bleeding profusely. A

medical alert bracelet indicates that he is on heparin therapy. Which medication will the nurse most likely administer to counteract the action of heparin? a. Warfarin sodium (Coumadin) b. Enoxaparin (Lovenox) c. Protamine sulfate d. Vitamin K ANS: C

Protamine sulfate is the antidote to heparin. With the patient‘s risk of fluid volume deficit as a result of trauma, the primary intervention would be to counteract the effects of heparin to prevent hemorrhage. Warfarin is an anticoagulant and would not counteract hemorrhage.

Lovenox is chemically related to heparin and would not counteract hemorrhage. Vitamin K is used to control the bleeding that results from use of warfarin (Coumadin), not heparin.

DIF: Cognitive Level: Comprehension REF: p. 428 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Perfusion | Safety

OBJ: 2 | 4

2. A patient receiving IV heparin therapy for a deep vein thrombosis (DVT) in his right calf asks

why his calf remains painful, edematous, and warm to touch after 2 days of anticoagulant therapy. Which response by the nurse is most accurate? a. ―It takes at least 3 days for the symptoms to resolve once the clot dissolves.‖ b. ―Heparin does not dissolve blood clots but neutralizes clotting factors, preventing extension of the clot and the possibility of it traveling elsewhere in your body.‖ c. ―I will report this to your healthcare provider because there may be a need to look at alternative treatments.‖ d. ―You appear anxious. The healthcare provider will eventually put you on ticlopidine, which allows for an earlier discharge.‖ ANS: B

Heparin is used to treat a thromboembolism and promote neutralization of activated clotting factors, preventing the extension of thrombi and the formation of emboli. Heparin will minimize tissue damage by preventing it from developing into an insoluble, stable thrombus.

It is inappropriate to tell a patient how long it will take to dissolve a clot. The patient‘s question does not warrant notification of the healthcare provider. Telling the patient that the healthcare provider will be starting the patient on ticlopidine is inappropriate and inaccurate.

DIF: Cognitive Level: Comprehension REF: p. 427 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Communication | Patient Education | Perfusion | Clotting 3. A patient is receiving IV heparin therapy. The aPTT is 90; the laboratory control is 30

seconds. Which nursing intervention is most accurate? a. Document in the nursing notes that these results are within therapeutic range. b. Note the RBC count and wait for the healthcare provider to make the next round to discuss all laboratory values. c. Stop the heparin drip. d. Assess the patient for signs and symptoms of decreased sensorium.

ANS: C

Heparin dosage is considered to be in the normal therapeutic range if the aPTT is 1.5 to 2.5 times the control value. The patient‘s aPTT value is above the therapeutic range, which puts her at risk for hemorrhage. The most appropriate nursing action would be to stop the heparin drip. These results cannot be documented as being within the normal therapeutic range. RBC count and mental status are not relevant in assessing therapeutic response to anticoagulation.

DIF: Cognitive Level: Application

REF: p. 428

OBJ: 4

NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 4. Which is an accurate nursing action when administering subcutaneous enoxaparin, a

low-molecular-weight heparin product? a. Expel the air bubble from the prefilled syringe. b. Leave the needle in place for 10 seconds after injection. c. Administer the medication into the deltoid muscle. d. Massage the site after injection to increase absorption.

ANS: B

The needle is left in place for 10 seconds after injection. Air is not expelled from the prefilled syringe. This medication is not administered intramuscularly. The site should not be massaged to increase absorption.

DIF: Cognitive Level: Application REF: p. 431 OBJ: 4 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety 5. A patient is receiving 1400 units of heparin/hr on an IV pump. The aPTT time is 54. The

laboratory control is 25. Which action by the nurse is accurate? a. Bolus the patient with an additional 5000 units of heparin. b. Stop the heparin immediately and notify the healthcare provider that the patient‘s blood level is toxic. c. Administer protamine sulfate stat. d. Continue with the prescribed rate.

ANS: D

Therapeutic heparin values are 1.5 to 2.5 times the control value. The therapeutic range of heparin with a control of 25 is 37.5 to 62.5 units/hr. A time of 54 is within the therapeutic range. An increase of heparin is not indicated because the patient is in the therapeutic range.

The range is not toxic. An antidote to the anticoagulant is not indicated because the patient is within the therapeutic range.

DIF: Cognitive Level: Application REF: p. 428 OBJ: 4 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Planning CON: Clinical Judgment | Safety 6. Which rationale is accurate for administering fibrinolytic agents, such as streptokinase, within

hours of the onset of myocardial infarction? a. Enhances myocardial oxygenation. b. Lyses the blood clot. c. Promotes platelet aggregation. d. Inhibits clotting mechanisms.

ANS: B

Fibrinolytic agents such as streptokinase dissolve or lyse recently formed thrombi. The goals of thrombolytic therapy are to lyse the thrombus during the early stages of clot formation, restore circulation to the areas distal to the thrombus, and reduce morbidity after thromboembolism formation. Fibrinolytic agents do not have an effect on myocardial oxygenation and do not promote platelet aggregation or inhibit clotting mechanisms.

DIF: Cognitive Level: Comprehension REF: p. 435 OBJ: 2 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Perfusion 7. Which mechanism of action applies to the use of drugs to treat thromboembolic disease? a. Dissolving clots and preventing formation of new clots b. Making platelets more flexible and preventing formation of new clots c. Causing vasodilation and increased blood flow d. Preventing platelet aggregation and inhibiting clot formation ANS: D

The pharmacologic agents used to treat thromboembolic disease act to prevent platelet aggregation or to inhibit a variety of steps in the fibrin clot formation cascade.

Thromboembolic medications do not dissolve clots, make platelets more flexible, or cause vasodilation.

DIF: Cognitive Level: Comprehension REF: p. 418 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Clotting | Perfusion 8. Dipyridamole (Persantine) has been used extensively in combination with warfarin to prevent

the formation of thromboembolism after which type of event? a. Myocardial infarction b. Transient ischemic attack c. Cardiac valve replacement d. Heart transplant ANS: C

Dipyridamole has been used extensively in combination with warfarin to prevent the formation of thromboembolism after cardiac valve replacement. Heparin is used to prevent clotting after myocardial infarction. Transient ischemic attacks are often treated with aspirin.

Transplant patients are treated postoperatively with immunosuppressant medications.

DIF: Cognitive Level: Comprehension REF: p. 433 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Perfusion | Clotting

OBJ: 1 | 2

9. Which action will the nurse implement to decrease the risk of clot formation in an older

patient on bed rest? a. Assess peripheral pulses. b. Encourage passive leg exercises. c. Limit fluid intake. d. Position pillows behind the knees.

ANS: B

Using active or passive leg exercises for a patient on bed rest will prevent clot formation.

Assessing pulses is not a preventive measure. Adequate hydration promotes fluidity of the blood and decreases the risk of clot formation. Placing pressure against the popliteal space will increase the risk of clot formation.

DIF: Cognitive Level: Application REF: p. 420 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Perfusion | Clotting

OBJ: 1

10. The nurse is teaching a patient about dietary implications while on warfarin (Coumadin)

therapy. Which salad is highest in vitamin K? a. Fruit b. Pasta c. Potato d. Spinach ANS: D

Green leafy vegetables contain vitamin K. DIF: Cognitive Level: Comprehension REF: p. 420 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Nutrition

OBJ: 4

11. Which statement by a patient recently prescribed warfarin (Coumadin) indicates the need for

further teaching? a. ―I will always wear a medical alert bracelet.‖ b. ―I will check with my healthcare provider before I take any OTC medications.‖ c. ―I will be careful when I use a knife or other sharp objects.‖ d. ―I will rinse my mouth with mouthwash instead of brushing my teeth.‖ ANS: D

Soft-bristled toothbrushes are acceptable to use for oral care. Medical alert bracelets should always be worn. The healthcare provider needs to be consulted prior to taking any OTC medications. Caution must be used when cutting with knives or using any sharp objects.

DIF: Cognitive Level: Comprehension REF: p. 432 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Patient Education | Tissue Integrity

OBJ: 3

12. Which symptom is indicative of bleeding in a patient taking warfarin (Coumadin)? a. Bradycardia b. Petechiae c. Increased urinary output d. Dry skin ANS: B

Petechiae are indicative of bleeding. These pinpoint red spots on the skin indicate intradermal hemorrhage. Bradycardia, increased urinary output, and dry skin are not indicative of bleeding.

DIF: Cognitive Level: Comprehension REF: p. 433 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety

13. Which action will the nurse take when caring for a 27-year-old woman on the postpartum unit

one day following a C-section to prevent clot formation? a. Position the patient with knees flexed. b. Initiate use of fitted thromboembolic disease deterrent (TED) stockings. c. Maintain complete bed rest. d. Implement deep breathing and coughing exercises.

ANS: D

Deep breathing and coughing exercises should be part of regular postoperative nursing care to prevent clot formation. Knees should not be flexed. TED stockings require a physician‘s order. Early, regular ambulation should be encouraged after surgery.

DIF: Cognitive Level: Application REF: p. 420 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Clotting | Perfusion 14. Rivaroxaban (Xarelto) is ordered on a patient following knee replacement surgery. Which

time period is accurate to convey when educating the patient on how long this treatment will continue? a. Only while hospitalized. b. For 35 days postsurgically. c. For 12 days postsurgically. d. As long as creatinine clearance is less than 30.

ANS: C

It is recommended that patients undergoing knee replacement continue treatment with rivaroxaban for 12 days postsurgically. It is recommended that patients undergoing hip replacement surgery continue treatment for 35 days postsurgically. Rivaroxaban should not be administered to patients with a creatinine clearance less than 30 mL/min.

DIF: Cognitive Level: Comprehension REF: p. 425 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 4

MULTIPLE RESPONSE 1. Which situation(s) will the use of anticoagulant therapy be anticipated? (Select all that apply.) a. To prevent stroke in patients at high risk b. Following a myocardial infarction c. Following total hip or knee joint replacement surgery d. With DVT e. To prevent thrombosis in immobilized patients f. Peptic ulcer disease ANS: A, B, C, D, E

Anticoagulant therapy is used to treat patients at high risk for stroke; patients with thromboembolic diseases, such as myocardial infarction; those at risk of developing thrombus resulting from underlying medical conditions or disease; and patients with thromboembolic diseases, such as DVT. Anticoagulant therapy is not used to treat patients with peptic ulcer disease.

DIF: Cognitive Level: Comprehension REF: p. 418 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Perfusion | Clotting

OBJ: 1 | 2

2. Which important point(s) will the nurse include when preparing discharge education for a

patient who will be receiving warfarin (Coumadin) at home? (Select all that apply.) a. ―Do not make any major changes to your diet without discussing it with your healthcare provider.‖ b. ―Keep outpatient laboratory appointments for monitoring of therapy.‖ c. ―Take the medication after meals.‖ d. ―Report signs of bleeding to your healthcare provider, including observing skin for bruising; petechiae; blood in emesis, urine, or stools; bleeding gums; cold, clammy skin; faintness; or altered sensorium.‖ e. ―Avoid aspirin products.‖ ANS: A, B, D, E

Although patients on anticoagulant therapy should have knowledge about foods high in vitamin K (green, leafy vegetables), they should not make any major changes to their diet without consulting with their healthcare provider, pharmacist, and/or nutritionist. Patients receiving anticoagulant therapy should maintain regular appointments for assessment of the drug‘s therapeutic effects and follow up with the healthcare provider for regular review of laboratory values and dosage monitoring. Regular self-assessment for signs of bleeding is necessary for patients on anticoagulant therapy. Patients on anticoagulant therapy should avoid aspirin products. Warfarin does not have to be taken after meals.

DIF: Cognitive Level: Comprehension REF: p. 432 | p. 433 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety 3. Which nursing intervention(s) would be accurate when administering heparin subcutaneously?

(Select all that apply.) a. Assessment of recent aPTT levels b. Massaging the site after injection of medication c. Aspirating after needle insertion d. Documenting ecchymotic areas e. Monitoring of vital signs ANS: D, E

Ecchymosis, or bruising, indicates bleeding below the dermis and should be assessed closely.

Patients on heparin therapy are prone to bleeding, which would lead to hemorrhagic shock.

Vital sign alterations would alert the nurse to internal bleeding. aPTT levels are required to be monitored for the intravenous route but not for subcutaneous injections. The injection site should not be massaged to reduce local bleeding. Aspiration may cause bruising when administering heparin subcutaneously.

DIF: Cognitive Level: Application REF: p. 428 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 4 CON: Clinical Judgment | Safety

4. Which way(s) describe(s) the action(s) of pharmacologic agents used to treat DVT? (Select all

that apply.) a. Prevent platelet aggregation. b. Prevent the extension of existing clots. c. Inhibit steps in the fibrin clot formation cascade. d. Prolong bleeding time. e. Lower serum triglycerides.

ANS: A, B, C, D

Agents used to treat DVT may prevent future clotting, may prevent the extension of clots, may inhibit steps in the formation of clots, and act to prolong bleeding time. Medications used to treat DVT do not lower serum triglyceride levels.

DIF: Cognitive Level: Comprehension REF: p. 418 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Perfusion | Clotting 5. Which action(s) will be taken when preparing to administer dalteparin (Fragmin) to a patient

in order to prevent DVT following a hip replacement? (Select all that apply.) a. Administer intramuscularly. b. Inject slowly. c. Remove needle immediately after injection. d. Rub injection site following administration. e. Alternate injection sites every 24 hours.

ANS: B, E

Dalteparin (Fragmin) should be injected slowly. Injection sites should be alternated every 24 hours. Dalteparin is administered by deep subcutaneous injection, not intramuscularly. Needle should be left in place for 10 seconds after injection. To minimize bruising, do not rub the injection site after completion of the injection.

DIF: Cognitive Level: Application REF: p. 429 | p. 430 OBJ: 2 | 3 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Skin Integrity

Chapter 27: Drugs Used to Treat Heart Failure Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition

MULTIPLE CHOICE 1. Which drug will be administered to a patient being admitted with severe digoxin intoxication? a. Amiodarone (Cordarone) b. Spironolactone (Aldactone) c. Digoxin immune Fab (Digibind) d. Digitalis glycoside ANS: C

The antidote for digoxin intoxication is digoxin immune Fab (Digibind). Amiodarone is an antidysrhythmic and would not treat digoxin intoxication. Spironolactone is a diuretic and does not treat digoxin intoxication. Giving more of the same type of drug does not treat drug intoxication.

DIF: Cognitive Level: Knowledge REF: p. 449 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 4 CON: Clinical Judgment | Safety

2. The nurse is caring for a 3-year-old girl who has a congenital heart anomaly. The patient‘s

current medications include digoxin and furosemide (Lasix). The apical pulse rate is 100 beats/min. Which action will the nurse take? a. Administer the medication. b. Contact the pediatric cardiologist for further orders. c. Hold the digoxin. d. Request that another unit nurse assess the child.

ANS: A

A pulse rate of 100 beats/min in a child who is 3 years old is considered acceptable.

Administration of the medication is appropriate. There is no indication for contacting the cardiologist, holding the dose, or requesting further assessment because this is within the expected range.

DIF: Cognitive Level: Application REF: p. 449 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 3. An older adult male patient with long-term heart failure has presented for an office visit. The

nurse obtains information that he has recently begun taking St. John‘s wort. Which results can occur with the use of this herbal supplement? a. Digoxin toxicity b. Altered potassium electrolyte balance c. Reduced therapeutic benefits of digoxin d. Enhanced digoxin effectiveness without producing toxicity ANS: C

St. John‘s wort is a drug that may reduce therapeutic benefits of digoxin. St. John‘s wort has the opposite effect on digoxin and does not affect electrolytes.

DIF: Cognitive Level: Comprehension REF: p. 450 OBJ: 3 | 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety

4. The nurse is to administer digoxin to an 18-month-old patient who weighs 16.5 lb. Guidelines

for administration read as follows: 0.0075 to 0.010 mg/kg/day. Which is a safe medication dosage? a. 0.05 mg b. 0.12 mg c. 0.074 mg d. 0.75 mg ANS: C

16.5 lb converts to 7.5 kg; 7.5 kg  0.0075 mg = 0.05625; 7.5 kg  0.010 mg = 0.075 mg; 0.074 mg is the only answer within the safe dosage range. Values of 0.05 mg, 0.12 mg, and 0.75 mg are too large.

DIF: Cognitive Level: Analysis REF: p. 449 | p. 450 OBJ: 3 | 5 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety 5. Which medication when given with digoxin increases the risk for toxicity? a. Potassium supplements b. Furosemide (Lasix) c. Acetylsalicylic acid (aspirin) d. Antibiotics ANS: B

Furosemide is a potassium-depleting diuretic. Low potassium levels potentiate digoxin toxicity. Taking potassium supplements with a diuretic prevents digoxin toxicity. Aspirin and antibiotics do not affect digoxin levels.

DIF: Cognitive Level: Knowledge REF: p. 450 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 6. Which initial manifestation of digoxin toxicity is assessed in children? a. Hallucinations b. Weakness c. Atrial dysrhythmia d. Diuresis ANS: C

In children, digoxin toxicity is often first detected by the development of atrial dysrhythmias.

Hallucinations, weakness, and diuresis are not initial manifestations of digoxin toxicity in children.

DIF: Cognitive Level: Knowledge REF: p. 449 OBJ: 4 | 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 7. Which agents stimulate the heart to increase the force of contractions, thereby increasing

cardiac output? a. Inotropic b. Chronotropic c. Isotonic

d. Isopropyl ANS: A

Inotropic agents stimulate the heart to increase the force of contractions, thus boosting cardiac output. Chronotropic agents are given to increase heart rate. Isotonic agents have the same pH as body fluids. Isopropyl agents include rubbing alcohol.

DIF: Cognitive Level: Knowledge REF: p. 440 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Perfusion 8. Which drug is used to obtain vasodilation in the treatment of chronic heart failure? a. ACTH b. ACE inhibitors c. ARBs d. ANB agents ANS: B

Angiotensin converting enzyme (ACE) inhibitors are the mainstays of oral vasodilator therapy for treating chronic heart failure. ACTH is adrenocorticotropic hormone, secreted by the anterior pituitary to stimulate the adrenal cortex. ARBs are angiotensin reuptake blockers, used for the treatment of hypertension. ANB agents are adrenergic neuron blocking agents, such as guanethidine, given for the treatment of hypertension.

DIF: Cognitive Level: Knowledge REF: p. 446 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Perfusion 9. Which action of ACE inhibitors results in effective treatment of heart failure? a. Increased afterload b. Increased aldosterone c. Increased preload d. Increased cardiac output ANS: D

The therapeutic outcome of ACE inhibitors in heart failure is to improve cardiac output. ACE inhibitors reduce afterload, inhibit the secretion of aldosterone, and reduce preload.

DIF: Cognitive Level: Comprehension REF: p. 446 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Perfusion 10. The nurse is providing teaching to a patient with heart failure who has been prescribed

nifedipine, a calcium channel blocker. Which statement by the nurse is accurate? a. ―This medication dilates your coronary arteries.‖ b. ―This medication will help your kidneys get rid of fluid.‖ c. ―This medication reduces volume returning to your heart so it doesn‘t overstretch.‖ d. ―This medication reduces the resistance your heart has to pump against.‖ ANS: D

This medication reduces afterload or the resistance against which the heart has to pump. This medication is not used in heart failure for this reason, does not have a diuretic effect, and does not reduce volume.

DIF: Cognitive Level: Comprehension REF: p. 443 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Perfusion

OBJ: 3 | 5

11. Which instruction by the nurse will be included when teaching an adult patient about digoxin

(Lanoxin) for management of heart failure? a. ―Report nausea and vomiting to your healthcare provider.‖ b. ―Decrease the amount of high potassium foods you eat.‖ c. ―Omit your dose of digoxin if your pulse is 60 beats/min.‖ d. ―Visual disturbances are common adverse effects.‖ ANS: A

Nausea and vomiting are serious adverse effects indicative of toxicity. Low potassium levels can cause toxicity; adequate intake of potassium is necessary. The dose is withheld if the pulse rate is less than 60 beats/min in adults. Visual disturbances are not common adverse effects.

DIF: Cognitive Level: Comprehension REF: p. 449 | p. 450 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety 12. Which nursing assessment is most important to determine fluid status for a patient with heart

failure? a. Auscultation of lungs b. Daily weights c. Intake and output d. Measurement of abdominal girth ANS: B

Daily weights are the best indicator of fluid gain or loss. Auscultation of lungs, measurement of intake and output, and measurement of abdominal girth are not the best indicators of fluid status.

DIF: Cognitive Level: Comprehension REF: p. 443 | p. 444 OBJ: 1 | 2 | 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Fluid and Electrolytes 13. Which position is best for the patient diagnosed with altered cardiac function when

auscultating their lung sounds? a. Prone b. Supine c. Sims‘ d. Fowler‘s ANS: D

Lung fields are assessed in a sitting (Fowler‘s) position to detect abnormal lung sounds.

Prone, supine, and Sims‘ positions are not the best positions to detect abnormal lung sounds.

DIF: Cognitive Level: Application REF: p. 444 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 14. Which time is appropriate to schedule the administration of a diuretic ordered for a patient

diagnosed with congestive heart failure? a. In the morning b. After lunch c. With dinner d. At bedtime ANS: A

Diuretics should be taken in the morning to avoid nighttime diuresis.

DIF: Cognitive Level: Application REF: p. 445 OBJ: 3 | 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Elimination MULTIPLE RESPONSE 1. The nurse is assessing an emergency department patient who was recently discharged

following a myocardial infarction (MI). Which symptom(s) would the nurse observe in this patient with left ventricular systolic failure? (Select all that apply.) a. Reports of recent weight loss b. Complaints of peripheral edema c. Diminished exercise tolerance d. Shortness of breath with activity e. Blood pressure elevation ANS: C, D

Early clinical symptoms of left ventricular failure are decreased exercise tolerance and poor perfusion to peripheral tissues. Patients who develop left ventricular systolic failure as a result of MI have acute shortness of breath. Weight gain is more likely to be reported because of edema in diastolic failure. Patients who develop left ventricular systolic failure as a result of MI have shock with little peripheral edema and hypotension.

DIF: Cognitive Level: Comprehension REF: p. 440 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Perfusion | Gas Exchange 2. Before administering digoxin (Lanoxin), the nurse takes the adult patient‘s apical pulse for 1

full minute. Which additional nursing consideration(s) will be taken before administration of the medication? (Select all that apply.) a. Review of the digoxin blood level b. Administration of the medication with pulse less than 60 beats/min c. Review of serum electrolytes, liver, and kidney function studies d. Administration of the medication with a pulse of 110 beats/min e. Obtaining baseline patient assessment data, including lung sounds, vital signs, and

weight ANS: A, C, E

Before administering digoxin, the nurse should review digoxin levels, review baseline diagnostic data (electrolytes, liver, and kidney function tests), obtain appropriate physical assessments for heart failure patients, and verify that pulse rate is between 60 and 100 beats/min.

DIF: Cognitive Level: Application REF: p. 449 OBJ: 3 | 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 3. Which action(s) will the nurse take when caring for a patient with heart failure? (Select all

that apply.) a. Administer diuretics at bedtime. b. Assess electrolyte levels. c. Report daily weight fluctuations. d. Encourage sodium intake. e. Maintain skin hygiene.

ANS: B, C, E

Ongoing assessment of electrolyte levels is critical when caring for a patient with heart failure. Weight gains and losses are the single best indicator of fluid gain or loss. The maintenance of skin care and changing of positions are essential to prevent skin breakdown.

Diuretics should be given in the morning and afternoon, not at bedtime, because this would interfere with sleep. Heart failure patients are prone to edema, which interferes with vascular return in the peripheral areas. Sodium restriction is one way of controlling edema.

DIF: Cognitive Level: Application REF: p. 444 OBJ: 2 | 5 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Fluid and Electrolytes | Skin Integrity 4. Which contributing factor(s) to heart failure is/are modifiable? (Select all that apply.) a. Hypertension b. Addiction to smoking c. Genetic history d. Exercise tolerance e. Age ANS: A, B, D

Hypertension, smoking, and diminished exercise tolerance are contributing factors to atherosclerosis, which can be modified with changes in behavior and the assistance of medications. Genetic history and age are not modifiable factors.

DIF: Cognitive Level: Comprehension REF: p. 440 OBJ: 1 | 5 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Health Promotion 5. Which statement(s) is/are true regarding valsartan-sacubitril (Entresto)? (Select all that

apply.) a. Increases preload

b. c. d. e.

Blocks angiotensin-mediated peripheral vasoconstriction Suppresses aldosterone It promotes norepinephrine secretion Causes vasodilation

ANS: B, C, E

Valsartan-sacubitril (Entresto) is a combination product containing an ARB (valsartan) and a neprilysin inhibitor (sacubitril). The ARB treats heart failure by reducing afterload by blocking angiotensin-mediated peripheral vasoconstriction with resultant vasodilation, and decreases preload by reducing circulating blood volume by inhibiting the secretion of aldosterone. Aldosterone inhibition results in a natriuresis (excretion of sodium in the urine) and diuresis (excretion of water in the urine).

DIF: Cognitive Level: Comprehension REF: p. 446 | p. 447 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Perfusion 6. Which statement(s) about vasodilators is/are true? (Select all that apply.) a. Reduce systemic vascular resistance. b. Hey increase afterload. c. Reduce preload. d. Decrease pulmonary congestion. e. Increase tissue perfusion to muscles and organs. f. Increase the volume of blood returning to the heart.

ANS: A, C, D, E

Vasodilators reduce systemic vascular resistance (afterload), decrease preload, relieve pulmonary congestion, and increase tissue perfusion to muscles and vital organs. Vasodilators reduce systemic vascular resistance (afterload) and reduce preload so that the high volume of blood returning to the heart is decreased.

DIF: Cognitive Level: Comprehension REF: p. 440 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Perfusion

OBJ: 3

7. Which instruction(s) should be provided to a patient diagnosed with altered cardiac function?

(Select all that apply.) a. Alcohol consumed in moderation b. Use of salt substitute c. Regular, mild exercise d. Good skin care e. Stress reduction ANS: C, D, E

Regular, mild exercise; good skin care; and stress reduction should be encouraged with a patient with altered cardiac function. Alcohol intake should be eliminated from the diet. Salt substitutes are high in potassium, so use must be limited.

DIF: Cognitive Level: Comprehension REF: p. 445 NAT: NCLEX Client Needs Category: Physiological Integrity

OBJ: 5

TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Perfusion | Skin Integrity | Health Promotion

Chapter 28: Drugs Used for Diuresis Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which effect would the nurse anticipate if a patient with a history of type 2 diabetes is

prescribed a thiazide diuretic? a. No change in the antidiabetic regimen b. Decreased need for antidiabetic medication c. Increased blood sugar levels d. Less frequent monitoring of blood sugar level ANS: C

The thiazides may induce hyperglycemia and aggravate cases of preexisting diabetes mellitus.

Regular assessment for glycosuria is indicated. Dosages of oral hypoglycemics and insulin may need adjustment in patients with diabetes mellitus. Thiazides affect glucose metabolism, and the patient should change her regimen to accommodate this. Thiazides have the opposite effect on glucose metabolism. More frequent monitoring is warranted when the patient is being treated with thiazide diuretics.

DIF: Cognitive Level: Comprehension REF: p. 462 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 2. Which electrolyte should the patient prescribed thiazide diuretics be instructed to increase the

intake of? a. Calcium b. Sodium c. Potassium d. Magnesium ANS: C

Thiazide diuretics cause a decrease in the level of potassium. The patient taking thiazide diuretics does not need to increase calcium or magnesium intake. Although sodium levels are altered in patients taking thiazide diuretics, patients do not need to increase sodium intake.

DIF: Cognitive Level: Comprehension REF: p. 462 OBJ: 4 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Nutrition | Health Promotion 3. On admission, a patient with a history of cardiac insufficiency complains of shortness of

breath. The nurse auscultates the lungs and notes bilateral crackles throughout both fields. In addition, there is bilateral +2 edema of the lower extremities. Which medication does the nurse anticipate that the healthcare provider will prescribe? a. Allopurinol (Zyloprim) b. Diphenhydramine (Benadryl) c. Mannitol

d. Furosemide (Lasix) ANS: D

Diuretics, such as furosemide, are the mainstays of treatment in heart failure and hypertension. Allopurinol is used to treat gout. Diphenhydramine is an antihistamine and is not used for diuresis. Mannitol is used mainly to treat cerebral edema.

DIF: Cognitive Level: Application REF: p. 458 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Gas Exchange | Perfusion 4. Which medication is a potassium sparing diuretic? a. Acetazolamide (Diamox) b. Spironolactone (Aldactone) c. Furosemide (Lasix) d. Bumetanide (Bumex) ANS: B

Spironolactone is a potassium sparing diuretic that blocks the sodium retaining and potassium and magnesium excreting properties of aldosterone. This results in loss of water, with increased sodium excretion and retention of potassium. Acetazolamide is a carbonic anhydrase inhibitor and does not spare potassium. Furosemide is a loop diuretic. Bumetanide is a loop diuretic and does not spare potassium.

DIF: Cognitive Level: Knowledge REF: p. 454 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Nutrition 5. Which time period identifies how soon diuresis will be expected to occur after the nurse has

administered 20 mg of furosemide (Lasix) intravenously (IV) to a patient with heart failure? a. As soon as injected b. Within 10 minutes c. After 2 hours d. After 4 hours ANS: B

The onset of diuresis following IV furosemide administration is 5 to 10 minutes after administration. The diuretic effect peaks within 30 minutes and lasts approximately 2 hours.

DIF: Cognitive Level: Comprehension REF: p. 458 | p. 459 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Elimination 6. Which foods will the nurse recommend for a patient taking loop diuretics? a. Protein-rich foods such as poultry, whole grains, and fish b. Fiber-rich foods such as yellow vegetables, nuts, and lentils c. Potassium-rich foods such as raisins, figs, and bananas d. Sodium-rich foods such as canned vegetables and processed foods ANS: C

Loop diuretics deplete potassium. Potassium-rich foods include raisins, figs, bananas, peaches, kiwis, dates, apricots, oranges, prunes, melons, broccoli, and potatoes. Protein- and fiber-rich foods are not needed in increased amounts by patients taking loop diuretics.

Because of high sodium content, canned foods are restricted for patients on diuretic therapy.

DIF: Cognitive Level: Comprehension REF: p. 459 OBJ: 4 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Nutrition 7. Which condition warrants the use of acetazolamide (Diamox) as a diuretic? a. Increased intracranial pressure b. Increased extravascular fluid pressure c. Increased intraocular pressure d. Periorbital edema ANS: C

Acetazolamide is used to reduce intraocular pressure associated with glaucoma. Mannitol is an osmotic diuretic used to decrease intracranial pressure. Diuretics such as furosemide or ethacrynic acid are used to reduce fluid volume in extravascular spaces. Diuretics are not used to treat periorbital edema.

DIF: Cognitive Level: Comprehension REF: p. 458 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 8. Which serum potassium level is expected in a patient who has severe vomiting and diarrhea? a. Less than 3.5 mEq/L b. Between 3.5 and 4.5 mEq/L c. Between 4.6 and 5 mEq/L d. Higher than 5.5 mEq/L ANS: A

Serum potassium (K+) levels would be less than 3.5 mEq/L. Hypokalemia is especially likely to occur when a patient exhibits vomiting, diarrhea, or heavy diuresis. Between 3.5 and 4.5 mEq/L is the low end of normal range for serum potassium. Between 4.6 and 5 mEq/L is the high end of normal range for serum potassium. Serum K+ levels higher than 5.5 mEq/L indicate hyperkalemia, which occurs most commonly when a patient is given excessive amounts of potassium supplementation.

DIF: Cognitive Level: Comprehension REF: p. 456 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Fluid and Electrolytes 9. Which medication, if administered with spironolactone (Aldactone), will alert the nurse to

assess the patient for signs and symptoms of hyperkalemia? a. Propranolol (Inderal) b. Captopril (Capoten) c. Furosemide (Lasix) d. Ibuprofen (Motrin) ANS: B

ACE inhibitors, such as captopril, inhibit aldosterone and thus may contribute to the development of hyperkalemia. Beta blockers, such as propranolol, do not affect potassium levels. Loop diuretics, such as furosemide, cause hypokalemia. NSAIDs, such as ibuprofen, do not affect potassium levels.

DIF: Cognitive Level: Comprehension REF: p. 464 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment 10. Which statement by a patient indicates the need for further teaching about potassium sparing

diuretic therapy? a. ―I will take my medication in the morning.‖ b. ―I will report a weight gain of 2 lb in 2 days.‖ c. ―I will rise slowly when I get up from a sitting position.‖ d. ―I will use a salt substitute because I limit my salt intake.‖ ANS: D

Salt substitutes are potentially dangerous because they are high in potassium.

DIF: Cognitive Level: Comprehension REF: p. 463 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Nutrition | Patient Education 11. Which patient assessment would alert the nurse to withhold a loop diuretic? a. Crackles in the lung bases b. +2 pitting peripheral edema c. Serum potassium of 2.6 mEq/L d. Weight gain of 2 lb in 2 days ANS: C

The serum potassium level of 2.6 mEq/L indicates hypokalemia and could worsen with the administration of a loop diuretic; therefore, the dose should be withheld. Crackles, peripheral edema, and weight gain do not warrant withholding the medication.

DIF: Cognitive Level: Application REF: p. 458 | p. 459 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Fluid and Electrolytes 12. A 37-year-old male presents at the emergency department reporting severe vomiting for the

past 48 hours. Which action will the nurse take when assessing skin turgor? a. Exert pressure against the shin. b. Gently pinch the skin together over the sternum. c. Assess for vein distention. d. Inspect oral mucous membranes.

ANS: B

Skin turgor is assessed by gently pinching the skin together over the sternum, on the forehead, or on the forearm. Elasticity is present and skin rapidly returns to a flat position in the well-hydrated patient. Exerting pressure against the shin would assess for edema. Vein distention and oral mucous membranes are indicators of hydration status but are not considered when assessing skin turgor.

DIF: Cognitive Level: Application REF: p. 455 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Fluid and Electrolytes 13. Which lab value will alert the nurse to notify the physician when reviewing lab work received

on a patient admitted with the diagnosis of dehydration? a. Serum sodium level: 115 mEq/L b. Serum potassium level: 5.0 mEq/L c. Serum sodium level: 140 mEq/L d. Serum potassium level: 3.5 mEq/L ANS: A

A serum sodium level lower than 135 mEq/L is considered hyponatremia. A serum potassium level of 3.5 or 5.0 mEq/L and a serum sodium level of 140 mEq/L are considered within normal limits.

DIF: Cognitive Level: Analysis REF: p. 456 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment | Nursing Process Step: Implementation CON: Clinical Judgment | Fluid and Electrolytes MULTIPLE RESPONSE 1. Which physical assessment(s) indicate(s) fluid volume excess? (Select all that apply.) a. Rapid, bounding, irregular pulse rate b. Clear lung sounds c. 3+ pitting ankle edema d. Neck vein engorgement e. Shortness of breath ANS: A, C, D, E

The patient with overhydration caused by heart failure often presents with a rapid and irregular pulse rate, peripheral and abdominal edema, distended neck veins, dyspnea and adventitious breath sounds of crackles and/or rhonchi in lung fields.

DIF: Cognitive Level: Comprehension REF: p. 456 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Fluid and Electrolytes 2. Which premedication assessment(s) would the nurse obtain prior to the initiation of

bumetanide (Bumex)? (Select all that apply.) a. Serum potassium b. Bowel sounds c. Lung sounds d. Orientation level e. Blood pressure ANS: A, C, D, E

Serum potassium levels may be altered because of bumetanide therapy and therefore need to be assessed. Lung sounds, orientation level, and vital signs need to be assessed prior to initiation of therapy. Bowel sounds are not generally assessed prior to bumetanide therapy.

DIF: Cognitive Level: Application REF: p. 458 | p. 459 OBJ: 1 | 2 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Fluid and Electrolytes 3. Which are common signs and symptoms of dehydration? (Select all that apply.) a. Furrowed tongue b. Decreased intake and output levels c. Bounding pulse rate d. Mental confusion e. Elastic skin turgor ANS: A, B, D

Furrowed tongue is a sign of dehydration. Signs of dehydration and hyponatremia include decreased intake and output or output greater than intake. Signs of dehydration may also include possible mental confusion, weak pulse/weak pedal pulses, inelastic skin turgor, and delayed capillary refill.

DIF: Cognitive Level: Comprehension REF: p. 455 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Fluid and Electrolytes 4. Which nursing intervention(s) would be performed for a patient who is on diuretic therapy?

(Select all that apply.) a. Auscultation of lung sounds b. Assessment of skin turgor c. Initiation of electrolyte supplements d. Positioning techniques e. Monitoring of intake and output ANS: A, B, D, E

Lungs should be auscultated to detect the presence of fluid as a result of heart failure. Skin turgor is directly related to the degree of hydration. Skin that is well hydrated is elastic and rapidly returns to a flat position after being pinched. In dehydrated patients, the skin remains in a peaked or pinched position and returns very slowly to the flat, normal position.

Positioning techniques are essential to avoid skin breakdown resulting from edema or dehydration. Assessment of intake and output will assist in determining the effectiveness of diuretic therapy. The healthcare provider, not the nurse, will determine the need for electrolyte supplementation. When ordered, the nurse will administer the appropriate replacements.

Maintaining the ordered diet therapy is within the role of the nurse.

DIF: Cognitive Level: Application REF: p. 456 OBJ: 1 | 4 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Fluid and Electrolytes 5. Which sign(s) and/or symptom(s) of dehydration may occur as a result of a diuretic? (Select

all that apply.) a. Decreased urine specific gravity b. Skin remains peaked on turgor assessment c. Bounding peripheral pulses

d. Neck vein engorgement e. Soft, sunken eyeballs ANS: B, E

A sign of dehydration is skin that is nonelastic or does not return to normal position when pulled taut on assessment. A sign of dehydration is eyeballs that appear soft or sunken.

Dehydrated patients have a urine specific gravity and weak pulses. Overhydrated patients have engorged neck veins.

DIF: Cognitive Level: Comprehension REF: p. 455 | p. 456 OBJ: 1 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Fluid and Electrolytes 6. Which medical condition(s) may contribute to fluid volume excess? (Select all that apply.) a. Hypertension b. Liver disease c. Pregnancy d. Use of corticosteroids e. Skin disorders ANS: A, B, C, D

Hypertension, underlying medical diseases of the liver, pregnancy, and use of corticosteroids may contribute to fluid volume excess. Skin disorders do not contribute to fluid volume excess.

DIF: Cognitive Level: Comprehension REF: p. 457 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Fluid and Electrolytes 7. Which disorder(s) contribute to the development of electrolyte disturbances during diuretic

therapy? (Select all that apply.) a. History of cardiac disease b. History of renal disease c. History of hormonal disorders d. History of psychiatric illness e. Massive trauma f. Serious burns g. Overhydration ANS: A, B, C, E, F

Patients with cardiac disease, renal disease, hormonal disorders, massive trauma, and serious burns are at risk for developing electrolyte imbalance during diuresis therapy. Psychiatric disorders do not have an effect on diuretic treatment. Although overhydration may cause an electrolyte disturbance, it is not related to diuretic treatment.

DIF: Cognitive Level: Comprehension REF: p. 456 OBJ: 1 | 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Fluid and Electrolytes 8. The nurse transcribes a new order for ethacrynic acid (Edecrin) on a patient with edema

resulting from cirrhosis of the liver. Which currently prescribed medication(s) should the nurse report to the ordering healthcare provider? (Select all that apply.)

a. b. c. d. e.

Digoxin Prednisone Tobramycin Lipitor Zofran

ANS: A, B, C

Drug interactions with ethacrynic acid (Edecrin) include digoxin, corticosteroids (such as prednisone), and aminoglycosides (such as tobramycin). Lipitor (a statin drug) and Zofran (an antiemetic) are not of concern when administered with ethacrynic acid.

DIF: Cognitive Level: Application REF: p. 461 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment | Nursing Process Step: Implementation CON: Clinical Judgment | Collaboration | Communication | Care Coordination

Chapter 29: Drugs Used to Treat Upper Respiratory Disease Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which is a serious adverse effect of decongestants? a. Hypotension b. Hypertension c. Orbital edema d. Facial flushing ANS: B

Sympathomimetic decongestants cause stimulation of the alpha-adrenergic receptors that can increase blood pressure. Excessive use of decongestants when taking a beta-adrenergic blocking agent or monoamine oxidase inhibitor can cause significant hypertension.

Alpha-receptor stimulation does not cause hypotension, orbital edema, or facial flushing.

DIF: Cognitive Level: Knowledge REF: p. 474 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Perfusion 2. Which time should antihistamines be administered? a. PRN throughout the day b. After contact with an allergen c. 45 minutes before exposure to an allergen d. Once nasal congestion begins ANS: C

Allergies may be seasonal or perennial. People are commonly allergic to more than one antigen simultaneously, so seasons may overlap or occur more than once per year.

Antihistamines do not prevent histamine release but reduce the symptoms of an allergic reaction by competing with the histamines for receptor sites. Antihistamines are most effective when taken 45 to 60 minutes before anticipated exposure to the allergen or when symptoms first appear. PRN use of antihistamines, waiting until after contact with an allergen, or waiting until nasal congestion begins is not the most effective administration of antihistamines.

DIF: Cognitive Level: Knowledge REF: p. 475 OBJ: 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Planning CON: Clinical Judgment | Patient Education | Health Promotion 3. Which effect can result if a patient overuses topical decongestants? a. Hypertensive crisis b. Allergic reaction c. Secondary congestion d. Permanent olfactory damage ANS: C

Overuse of topical decongestants may lead to a rebound or increase in nasal secretions, causing a secondary congestion (known as rhinitis medicamentosa). This secondary congestion is thought to be caused by excessive vasoconstriction of blood vessels and direct irritation of the mucous membranes by the medication. As vasoconstriction wears off, the irritation triggers excessive blood flow to the passages, which in turn causes swelling and engorgement to reappear in greater intensity. Although decongestants can cause elevated blood pressure, they are not likely to cause hypertensive crisis. Allergic reaction is unlikely with decongestants. Damage to nasal tissues resulting from the use of decongestants is unlikely to be permanent.

DIF: Cognitive Level: Comprehension REF: p. 471 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 4. A patient at sports camp is complaining of itchy and watery eyes, coughing, and sneezing

when outdoors. The patient‘s chart states that he has an allergy to grasses. Which medication will the nurse administer? a. Antitussive b. Expectorant c. Antihistamine d. Decongestant ANS: C

Antihistamines are used for inflammation and swelling resulting from the release of histamine during an antigen-antibody reaction. A grass allergy means that the patient experiences a release of histamine (antibody reaction) when exposed to the antigen, grass. Antitussive medications are for relief of cough. Expectorants are for the loosening of mucus so the patient can expel it by coughing. Decongestants would not help these symptoms as much as antihistamines.

DIF: Cognitive Level: Comprehension REF: p. 472 | p. 475 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment 5. Which medication may be given to patients with allergic seasonal rhinitis who do not respond

to antihistamines and sympathomimetics? a. Leukotrienes b. Mineralocorticoids c. Corticosteroids d. Cortisol ANS: C

Corticosteroids, whether applied topically or administered systemically, have been shown to be highly effective for the treatment of allergic rhinitis. Leukotrienes, made in the body, are mediators of the inflammatory response. Mineralocorticoids do not affect allergic responses.

Cortisol is not the steroid of choice for the treatment of an allergic response.

DIF: Cognitive Level: Knowledge REF: p. 473 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 2 CON: Clinical Judgment

6. Which physiologic rationale explains what initiates the sneeze reflex? a. Stimulation of the vagus nerve b. Irritation of the nasal mucosa by foreign particulate matter c. Stimulation of the tonsils d. Enervation of the olfactory cranial nerve ANS: B

Sneezing is a physiologic reflex used by the body to clear the nasal passages of foreign matter.

Stimulation of the vagus nerve, stimulation of the tonsils, and enervation of the olfactory cranial nerve are not what initiate the sneezing reflex.

DIF: Cognitive Level: Comprehension REF: p. 470 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 7. Which reaction occurs in the nasal structures when cholinergic fibers are stimulated? a. Dryness of mucous membranes in the nostrils b. Bleeding in the mucous membranes in the nostrils c. Production of serous and mucous secretions in the nostrils d. Enhanced olfactory perception in the mucous membranes of the nostrils ANS: C

The cholinergic fibers innervate the secretory glands; when stimulated, they produce serous and mucous secretions within the nostrils. Nasal dryness is the result of treatment with anticholinergic medications. Bleeding may be a result of overtreatment with anticholinergic medications, as a result of dryness of the nasal mucous membranes. Medications tend to dull olfactory function rather than enhance it.

DIF: Cognitive Level: Comprehension REF: p. 469 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment

8. Which process in the antigen-antibody reaction causes the symptoms of allergies? a. Release of antihistamines b. Production of antibodies c. Suppression of histamine d. Release of histamine ANS: D

One of the major causes of symptoms associated with an allergy is the release of histamine during the antigen-antibody reaction. Antihistamines suppress the symptoms of allergic reactions. Antibodies are not responsible for the allergic symptoms. Suppressing histamine diminishes the symptoms of allergies.

DIF: Cognitive Level: Comprehension REF: p. 471 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Immunity 9. Which instruction will the nurse include when teaching a patient with seasonal rhinitis and

blocked nasal passages about intranasal corticosteroid therapy? a. ―Clear your nasal passage after administration.‖ b. ―Anticipate a therapeutic benefit within 24 hours.‖ c. ―Use a decongestant prior to administration.‖ d. ―Report nasal burning to your healthcare provider.‖ ANS: C

Use of a decongestant just before intranasal corticosteroid administration ensures adequate penetration. The patient should clear the nasal passages before, not after, administration. The therapeutic benefit occurs after 24 hours. Nasal burning tends to resolve with continued therapy.

DIF: Cognitive Level: Application REF: p. 477 | p. 478 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education 10. Which symptom should the nurse prioritize as the most important when assessing a patient

being seen for a severe allergic reaction to environmental allergens? a. Hypotension b. Urticaria c. Dyspnea d. Rhinorrhea ANS: C

Dyspnea (difficulty breathing) caused by constriction and spasm of the bronchial tubes is the priority. Hypotension (low blood pressure), urticaria (severe itching), and rhinorrhea (running nose) can occur during a severe allergic reaction but are not the priority.

DIF: Cognitive Level: Application REF: p. 471 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety

11. A college student is being seen at an outpatient clinic with reports of allergic rhinitis and

conjunctivitis. Which information will be provided when the healthcare provider orders fexofenadine (Allegra)? a. Fexofenadine (Allegra) is one of the least sedating antihistamines. b. Tolerance will not develop. c. Antihistamines are more effective if taken after histamine is released. d. Histamine release will be prevented by this medication.

ANS: A

Fexofenadine (Allegra) is one of the least sedating antihistamines. Occasionally, a tolerance to antihistaminic effects will develop. Antihistamines are more effective if taken before histamine is released. Histamine release is not prevented by this medication. Symptoms are reduced.

DIF: Cognitive Level: Comprehension REF: p. 475 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 1 | 2 | 4

MULTIPLE RESPONSE 1. Which rationale explains when allergic rhinitis occurs? (Select all that apply.) a. Nasal mucosa become inflamed. b. Exposure as a result of an allergen produces inflammation. c. Histamine is released following allergen exposure. d. The weather is cold during the winter. e. A person has an initial exposure to an antigen.

ANS: A, B, C

Allergic rhinitis is inflammation resulting from an allergic reaction. Following allergen exposure, and with subsequent inhalation of the allergen, an antigen-antibody reaction occurs, causing inflammation and swelling of the nasal passages. Histamine is released during the allergic reaction. Allergic rhinitis can occur during any season, depending on when the allergen is most abundant in the air. Allergic rhinitis occurs in patients who have experienced previous exposure to one or more allergens and have developed antibodies.

DIF: Cognitive Level: Comprehension REF: p. 472 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 2. Which action(s) is/are true of antihistamines? (Select all that apply.) a. Reduce inflammation locally. b. Antagonize H1 receptors. c. May be administered orally. d. Are systemically distributed. e. Reduce nasal congestion.

ANS: A, B, C, D

Antihistamines reduce the symptoms of nasal itching, sneezing, rhinorrhea, lacrimation, and conjunctival itching through local and systemic actions. Antihistamines are H1 antagonists or blockers, may be administered orally, are distributed systemically, and do not reduce nasal congestion.

DIF: Cognitive Level: Knowledge REF: p. 475 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 3. Which information will the nurse include when preparing education for a patient who has

developed rebound nasal congestion resulting from use of topical decongestants? (Select all that apply.) a. For future topical decongestant use, follow the dosage directions daily. Do not overuse. b. Stop the topical decongestant at once. c. A decrease in congestion will occur immediately. d. Nasal steroid solutions can be used but may take several days to reduce inflammation and congestion. e. Use nasal saline spray to moisturize irritated mucosa.

ANS: A, B, D, E

The best treatment for rebound nasal congestion caused by use of topical decongestants is prevention. Further use of the medication will exacerbate the nasal congestion. Nasal steroid solutions may help gradually reduce the congestion without exacerbating the symptoms. Nasal saline spray will bring comfort to the irritated nasal mucosa by moisturizing them. A decrease in the nasal congestion will occur gradually.

DIF: Cognitive Level: Comprehension REF: p. 474 OBJ: 2 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety | Health Promotion 4. Which patient(s) would be able to take an alpha-adrenergic decongestant safely? (Select all

that apply.) a. 24-year-old woman with allergic rhinitis b. 18-year-old man with cold symptoms c. 64-year-old woman with a history of heart disease d. 70-year-old woman with glaucoma e. 56-year-old man with prostatic hypertrophy ANS: A, B

A 24-year-old woman with allergic rhinitis and an 18-year-old man with cold symptoms should be able to take an alpha-adrenergic decongestant safely. Alpha-adrenergic decongestants will stimulate alpha receptors throughout the body. Therefore, oral therapy should be prescribed with caution in patients with a history of cardiac disease, intraocular pressure, or prostatic hypertrophy.

DIF: Cognitive Level: Analysis REF: p. 474 | p. 475 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety

5. Which principle(s) will the nurse include in a teaching plan for antihistamine therapy? (Select

all that apply.) a. It is typical to experience an increase in energy. b. Dietary fiber and fluids should be increased. c. Do not take with prescription medications unless approved by a physician. d. Blurred vision is an expected adverse effect. e. Over-the-counter (OTC) medications are safe to use with any currently prescribed prescription medications.

ANS: B, C, D

All histamines cause anticholinergic adverse effects such as dry mouth, constipation, and urinary retention. Therefore, fluids and fiber should be increased in the diet when taking antihistamines. It is important to seek approval from the healthcare provider if currently using other scheduled medications with antihistamines. Blurred vision is an adverse effect of antihistamine use; patients should be urged to use caution because their cognitive and sensory abilities are impaired. Because of the sedative effect of most antihistamines, patients feel a decrease in energy. OTC medications must be approved by the healthcare provider to prevent drug interactions.

DIF: Cognitive Level: Comprehension REF: p. 475 | p. 476 | p. 477 OBJ: 2 | 4 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Planning CON: Clinical Judgment | Patient Education | Safety 6. Which topically active aerosol steroids are highly effective for reducing sneezing, nasal

itching, stuffiness, and rhinorrhea? (Select all that apply.) a. Beclomethasone (Beconase AQ) b. Prednisone (Deltasone) c. Fluticasone (Flonase) d. Flunisolide (Nasarel) e. Budesonide (Rhinocort Aqua) ANS: A, C, D, E

Beclomethasone, fluticasone, flunisolide, and budesonide are drugs used to reduce sneezing, nasal itching, stuffiness, and rhinorrhea. Prednisone is not used to treat these symptoms.

DIF: Cognitive Level: Comprehension REF: p. 477 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 2 CON: Clinical Judgment

7. Which information should be relayed to the patient when providing counseling on cromolyn

sodium (Nasalcrom) nasal spray? (Select all that apply.) a. Cromolyn must be taken immediately following exposure to the stimulus. b. The patient should blow the nose before nasal instillation. c. Therapeutic effects are immediate. d. Inhalation will cause coughing. e. The maximum is six sprays in each nostril daily.

ANS: B, E

Patients should blow their noses before nasal instillation. The maximum is six sprays in each nostril daily. Cromolyn must be taken before exposure to the stimulus that initiates an attack or allergic rhinitis. Therapeutic effects require regular use and are usually evident within 2 to 4 weeks. Coughing is not an expected adverse effect. The healthcare provider should be notified if inhalation causes coughing.

DIF: Cognitive Level: Application REF: p. 479 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety

OBJ: 2 | 4

Chapter 30: Drugs Used to Treat Lower Respiratory Disease Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which response by the nurse is the best when a patient has questions regarding a recently

prescribed antitussive agent? a. ―It will eliminate your cough at night.‖ b. ―It will reduce the frequency of your cough.‖ c. ―It should be used in the morning.‖ d. ―It should be taken before sleep.‖ ANS: B

Antitussive agents act by suppressing the cough center in the brain. The expected therapeutic outcome is reduced frequency of nonproductive cough to promote rest. Antitussive agents should be taken as prescribed by the healthcare provider. Antitussives are not likely to eliminate a cough. Antitussives should be taken throughout the day.

DIF: Cognitive Level: Comprehension REF: p. 488 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 2

2. Which is a common expectorant in over-the-counter medications? a. Dextromethorphan b. Diphenhydramine c. Guaifenesin d. Codeine ANS: C

Guaifenesin is used for symptomatic relief of conditions characterized by a dry, nonproductive cough such as the common cold, bronchitis, laryngitis, pharyngitis, and sinusitis. Guaifenesin is also used to remove mucous plugs from the respiratory tract.

Dextromethorphan is an antitussive. Diphenhydramine is an anticholinergic agent with antihistaminic and antitussive properties. Codeine is an antitussive.

DIF: Cognitive Level: Knowledge REF: p. 493 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment

3. Which reason is correct for administering sodium chloride to a patient with emphysema? a. Increases blood sodium levels b. Decreases mucus viscosity c. Reduces metabolic needs of the body d. Decreases bronchial irritation ANS: B

Sodium chloride acts by hydrating mucus. This will decrease the viscosity of mucous plugs, which makes it easier for patients to cough up the dry hardened plugs blocking the bronchial tubes. Sodium chloride is not given to increase serum sodium iodide levels. Sodium does not reduce metabolic needs of the body or bronchial irritation.

DIF: Cognitive Level: Comprehension REF: p. 493 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Gas Exchange

OBJ: 2

4. Which action will the nurse take when within minutes of the initiation of a nebulizer treatment

with a sympathomimetic bronchodilator, the patient turns on their call light and states that they feels ―panicky‖ and their heart is racing? a. Reassure the patient this is expected. b. Add more diluents to the nebulizer. c. Administer a sedative. d. Stop treatment and notify the healthcare provider.

ANS: D

Sympathomimetic drugs increase sympathetic nervous stimulation. Symptoms such as nervousness, palpitations, tremors, tachycardia, and anxiety typically are dose related. These symptoms should be reported to the healthcare provider immediately because the patient may require a decreased dosage. These symptoms could lead to further complications if allowed to persist and are not common adverse effects. Although this may be a common result, it is not an expected outcome. Diluting the medication would not decrease the dose. Although a sedative might be appropriate for the patient, this is not the intervention of choice.

DIF: Cognitive Level: Application REF: p. 497 OBJ: 4 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Planning CON: Clinical Judgment | Gas Exchange | Safety 5. Which condition will premedication assessments before the use of anticholinergic

bronchodilating agents verify that the patient does not have in their history? a. Diabetes b. Hypertension c. Liver disease d. Glaucoma ANS: D

Anticholinergic bronchodilating agents cause mydriasis (dilation of the pupils) and cycloplegia (loss of power in the ciliary muscle); therefore, they should not be used in patients with a history of closed-angle glaucoma. Diabetes, hypertension, and liver disease are not affected by the use of anticholinergic bronchodilating agents.

DIF: Cognitive Level: Comprehension

REF: p. 499

OBJ: 4

NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 6. A patient is seen in the emergency department. The patient had been maintained on

theophylline (Theo Dur), and a blood sample reveals the serum theophylline level is subtherapeutic. Which may cause a subtherapeutic serum level? a. Cimetidine use b. Drug tolerance c. Smoking d. Overuse of the inhaler ANS: C

The patient is not tolerant to the drug if the serum theophylline levels are too low. Cimetidine would enhance the effects of theophylline, not decrease the effects. Smoking reduces the therapeutic effects of xanthine derivatives, including theophylline. Overuse of the inhaler would cause a high level of serum theophylline.

DIF: Cognitive Level: Comprehension REF: p. 492 OBJ: 4 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 7. Which action is accurate when referencing zafirlukast (Accolate)? a. Dilates the alveolar sacs. b. Decreases leukotriene release. c. Inhibits histamine release. d. Increases viscosity of secretions.

ANS: B

Leukotrienes are a class of anti-inflammatory agents that block leukotriene formation, and they are part of the inflammatory pathway that causes bronchoconstriction. Leukotrienes work to reduce bronchoconstriction, and they do not inhibit histamine release or affect viscosity of secretions.

DIF: Cognitive Level: Knowledge REF: p. 499 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: N/A CON: Clinical Judgment

8. Which condition is albuterol (Proventil) used to treat? a. Acute bronchospasm b. Acute allergies c. Nasal congestion d. Dyspnea on exertion ANS: A

The short-acting beta agonists have a rapid onset (few minutes) and are used to treat acute bronchospasm. Beta agonists are not used to treat allergies. Decongestants are used for nasal congestion. Long-acting beta agonists are used for exertional dyspnea.

DIF: Cognitive Level: Knowledge REF: p. 496 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment

9. Which explanation describes where fluids of the respiratory tract originate? a. Specialized mucous glands called goblet cells b. Lymph fluid drawn across nasal membranes by osmosis c. Specialized beta cells in the islets of Langerhans d. Cells that produce aqueous humor ANS: A

The fluids of the respiratory tract originate from specialized mucous glands (goblet cells) and serous glands that line the respiratory tract. The goblet cells produce gelatinous mucus that forms a thin layer over the interior surfaces of the trachea, bronchi, and bronchioles. Lymph does not make up fluid in the respiratory tract. The beta cells in the islets of Langerhans are located in the pancreas. Cells that produce aqueous humor are located in the interior of the eye.

DIF: Cognitive Level: Knowledge REF: p. 483 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 10. Which structures in the respiratory tract assist in removing foreign bodies such as smoke and

bacteria? a. Villi b. Golgi bodies c. Ciliary hairs d. Erector pili ANS: C

Normally, respiratory tract fluid forms a protective layer over the trachea, bronchi, and bronchioles. Foreign bodies, such as smoke particles and bacteria, are caught in the respiratory tract fluid and are swept upward by ciliary hairs that line the bronchi and trachea to the larynx, where they are removed by the cough reflex. The villi are hair-like protrusions into the intestine emanating from the wall of the intestine. The purpose of the villi is to slow the passage of food and allow food particles to be captured among these finger-like villi so that the blood inside the villi can absorb the nutrients in the food. The primary function of the Golgi apparatus, an organelle found in most eukaryotic cells, is to process proteins targeted to the plasma membrane, lysosomes, or endosomes and those that will be formed from the cell and to sort them within vesicles. Thus, it functions as a central delivery system for the cell.

Erector pili are small muscles that cause hairs on the skin to rise when contracted.

DIF: Cognitive Level: Knowledge REF: p. 483 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 11. The nurse is providing instruction about ipratropium (Atrovent) to a patient with chronic

obstructive pulmonary disease (COPD). Which common adverse effect tends to resolve with therapy? a. Anxiety b. Dry mouth c. Tachycardia d. Urine retention ANS: B

Dry mouth is usually mild and tends to resolve with continued therapy. Anxiety, tachycardia, and urine retention are not common adverse effects.

DIF: Cognitive Level: Knowledge REF: p. 499 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety

OBJ: 4 | 5

12. An adult patient is admitted for an asthma attack. Which assessment obtained by the nurse

would support that albuterol (Proventil) was effective? a. Decrease in wheezing present on auscultation b. Less dyspnea while positioned in a high Fowler‘s position c. Sputum production is clear and watery d. Respiratory rate decreased to 38 breaths/min ANS: A

A bronchodilator would open the airways and result in a reduction of wheezing. Less dyspnea while positioned in a high Fowler‘s position, clear and watery sputum, and a respiratory rate decreased to 38 breaths/min would not indicate that the medication was effective.

DIF: Cognitive Level: Application REF: p. 499 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Gas Exchange 13. Which statement by a mother whose child has been diagnosed with asthma indicates a need

for further teaching? a. ―I will place the stuffed animals in the freezer overnight.‖ b. ―We will confine our dog to the kitchen area.‖ c. ―I should wash bedding in hot water.‖ d. ―A damp cloth should be used when I dust.‖ ANS: B

Pets should be removed from the home or kept outside if at all possible.

DIF: Cognitive Level: Application REF: p. 492 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Patient Education | Communication | Safety | Health Promotion 14. The nurse is providing nutrition information to a patient diagnosed with a lower respiratory

tract disease. Which rationale is correct for limiting caffeine? a. Caffeine increases the respiratory rate. b. Caffeine can result in thicker lung secretions. c. Caffeine will increase the anxiety response associated with dyspnea. d. Caffeine can cause bronchospasm.

ANS: B

Avoid caffeine-containing beverages because caffeine is a weak diuretic. Diuresis promotes thickening of lung secretions, making it more difficult to expectorate them.

DIF: Cognitive Level: Comprehension REF: p. 491 | p. 492 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity

TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Gas Exchange | Nutrition | Patient Education 15. Which information provided by the nurse is accurate when teaching a patient with a history of

COPD to self-administer tiotropium (Spiriva) by dry powder inhalation? a. The medication capsules can be used multiple times. b. Press on the canister while inhaling. c. Avoid breathing into the mouthpiece. d. Wash the device with cold water.

ANS: C

The patient should not breathe into the mouthpiece at any time. Capsules are meant to be used as a single dose and should be disposed of after taking the daily dose. The HandiHaler uses capsules of medication that should be pierced before the patient inhales. The inhaler should be washed with hot water.

DIF: Cognitive Level: Comprehension REF: p. 498 | p. 499 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education 16. The healthcare provider in an outpatient clinic has prescribed omalizumab (Xolair) to a

patient. Which primary outcome will the nurse teach the patient to expect? a. Easier expectoration of phlegm b. Less frequent asthma exacerbations c. Increased moisture of the mucous membranes d. Liquefaction of thick secretions ANS: B

The primary therapeutic outcome associated with omalizumab therapy is reduced frequency of acute asthmatic exacerbations. Easier expectoration of phlegm, increased moisture of the mucous membranes, and liquefaction of thick secretions are not outcomes of omalizumab.

DIF: Cognitive Level: Comprehension REF: p. 503 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 4

17. Which number indicates the correct calculation of the pack years when a patient reports

smoking one pack of cigarettes per day for the past 20 years? a. 5 b. 10 c. 20 d. 40 ANS: C

Pack years is defined as number of packs of cigarettes smoked per day times the number of years of smoking; 1 ´ 20 = 20.

DIF: Cognitive Level: Analysis REF: p. 489 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment

18. A resident in a long-term care facility diagnosed with COPD has a new medication order for

indacaterol. Which information will be included when the nurse is providing medication education to the resident? a. It is a short-acting beta antagonist. b. The patient should wait approximately 5 minutes between inhalations. c. Onset of action is within 5 minutes. d. Duration of action is about 12 hours.

ANS: C

Onset of action is within 5 minutes. Indacaterol is an ultra-long-acting beta 2 agonist.

Patients using inhaled bronchodilators should wait approximately 10 minutes. Duration of action is about 24 hours.

DIF: Cognitive Level: Comprehension REF: p. 489 | p. 499-501 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety MULTIPLE RESPONSE 1. Which statement(s) is/are true regarding the nursing assessment of a patient with a respiratory

disorder? (Select all that apply.) a. Central cyanosis typically is observed on the fingers and earlobes. b. Clubbing of the fingernails is a sign of hypoxia. c. As oxygen levels diminish, mental alertness will progressively deteriorate. d. The normal respiratory rate in an adult is 10 breaths/min. e. Episodes of apnea are present in Cheyne-Stokes.

ANS: B, C, E

Fingernail clubbing is a sign of hypoxia. Mental status will deteriorate as the oxygen level in the body diminishes. Apnea is present in Cheyne-Stokes respirations. Central cyanosis is not observed on the fingers and earlobes. The normal respiratory rate in an adult is more than 10 breaths/min.

DIF: Cognitive Level: Comprehension REF: p. 490 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Gas Exchange 2. Which statement is true about arterial blood gases (ABGs)? (Select all that apply.) a. They are measured from an arterial sample. b. They measure partial pressures of carbon dioxide. c. They measure blood pH. d. They measure partial pressures of sodium. e. They measure partial pressures of oxygen.

ANS: A, B, C, E

ABGs are taken from samples from arterial blood, which must be drawn and analyzed immediately. ABGs measure partial pressures of carbon dioxide and bicarbonate, pH, and partial pressures of oxygen. ABGs do not measure partial pressures of sodium.

DIF: Cognitive Level: Comprehension REF: p. 484 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Gas Exchange 3. Which assessments would be most important to include in obtaining the history on an older

adult patient with a history of COPD whose diagnosis is pneumonia? (Select all that apply.) a. Smoking history and exposure to secondhand smoke b. Current medications c. Chief complaint and onset of symptoms d. Support system e. Home oxygen use f. Liver function ANS: A, B, C, D, E

It is important to assess present and past respiratory history (including smoking history and exposure to secondhand smoke), obtain thorough medication history, ascertain the chief complaint and current pulmonary symptoms (including cough and sputum color), determine the patient‘s support system, and ask about any home treatments when obtaining information from a patient with acute and chronic lung disease. Liver function testing is not necessary for the assessment of this patient.

DIF: Cognitive Level: Comprehension REF: p. 489 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 4. Which physical assessment(s) would be pertinent to the patient with asthma? (Select all that

apply.) a. Lung sounds b. Patient color c. Respiratory rate and effort d. Peak expiratory flow e. Pulse oximetry reading f. Bowel sounds ANS: A, B, C, D, E

Lung sounds, pallor and color, respiratory rate and effort, peak expiratory flow, and pulse oximetry should be assessed in the patient with asthma. Assessment of bowel sounds is not pertinent.

DIF: Cognitive Level: Application REF: p. 489 | p. 490 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Gas Exchange | Safety 5. Which principle(s) would be when teaching a patient to use a steroid inhaler? (Select all that

apply.) a. Frequent oral hygiene is necessary. b. The inhaler should be used on a PRN basis only. c. Rinse and spit after inhalation of the medication. d. When taking a steroid drug as well as a bronchodilator, the bronchodilator should be administered first. e. Hold the breath for 10 seconds during inhalation of the medication.

ANS: A, C, D, E

Steroid medications may predispose patients to secondary fungal infections in the mouth. To prevent this, patients should be instructed on good oral hygiene technique and told to gargle and rinse the mouth with a hydrogen peroxide mouthwash after each aerosol treatment. In addition to good oral hygiene, patients should rinse and spit after inhalation of the medication.

When a bronchodilator and steroid are prescribed, the bronchodilator should be administered as the first puff of medication and, after waiting a few minutes, the steroid medication should be administered. This procedure facilitates bronchodilation so that the second medication will have a better chance of reaching lower parts of the lungs. Patients should hold their breath for 10 seconds during inhalation of the medication so that the medication is fully inhaled. Steroid inhalers should be used on a regular basis to prevent symptoms.

DIF: Cognitive Level: Comprehension REF: p. 499-501 OBJ: 5 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety | Health Promotion 6. Which statement(s) about acetylcysteine is/are true? (Select all that apply.) a. It reduces viscosity of secretions. b. It treats acetaminophen toxicity. c. It is stored at room temperature. d. It is given to improve airway flow. e. It is odorless. f. It is administered by inhalation.

ANS: A, B, D, F

Acetylcysteine is given to reduce the viscosity of secretions, used to treat acetaminophen toxicity, used to improve airway flow, and is a mucolytic given by inhalation. Acetylcysteine should be refrigerated after opening and has an odor similar to that of rotten eggs.

DIF: Cognitive Level: Comprehension REF: p. 495 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Gas Exchange 7. Which statement(s) about ipratropium bromide (Atrovent) is/are true? (Select all that apply.) a. It is administered by aerosol inhalation. b. It relieves nasal congestion. c. It decreases mucus secretion. d. It has minimal effect on ciliary activity. e. It is used for short-term treatment of bronchospasm. f. It may cause tachycardia or urinary retention.

ANS: A, D, F

Ipratropium bromide is administered by aerosol inhalation, has minimal effect on ciliary activity, and may cause tachycardia, urinary retention, or exacerbation of pulmonary symptoms. Ipratropium bromide does not relieve nasal congestion; has minimal effect on mucous secretion, sputum volume, and viscosity; and is used as a bronchodilator for long-term treatment of reversible bronchospasm associated with COPD. DIF: Cognitive Level: Comprehension REF: p. 498 | p. 499 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity

TOP: Nursing Process Step: Planning

CON: Clinical Judgment | Gas Exchange

8. Which instructions will be provided to the patient when administering two inhalations of

ipratropium bromide (Atrovent)? (Select all that apply.) a. Hold the canister horizontally. b. Keep the eyes closed. c. Exhale through the mouthpiece. d. Wait 15 seconds before the second inhalation. e. Shake the canister thoroughly prior to use.

ANS: B, D, E

The eyes should be kept closed because temporary blurred vision may result if the aerosol is sprayed into the eyes. The patient should wait approximately 15 seconds and repeat the second inhalation. The canister should be shaken thoroughly prior to use. The base of the canister should be held vertically. The patient should inhale through the mouthpiece.

DIF: Cognitive Level: Comprehension REF: p. 498 | p. 499 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

Chapter 31: Drugs Used to Treat Oral Disorders Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which adverse effect is associated with the use of a corticosteroid inhaler? a. Mucositis b. Plaque c. Xerostomia d. Candidiasis ANS: D

Medications that predispose a patient to candidiasis are those that suppress the immune system, including immunosuppressants, corticosteroids, cytotoxics, and broad spectrum antibiotics. Educating patients on the importance of oral hygiene following prescribed inhalation dosages will assist in decreasing this complication. Mucositis, plaque, and xerostomia are not associated with steroid inhaler use.

DIF: Cognitive Level: Knowledge REF: p. 509 | p. 510 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Infection 2. Which condition is present when white, milk curd-appearing plaques are observed attached to

the oral mucosa? a. Thrush b. Canker sores c. Cold sores d. Mucositis ANS: A

Thrush is characterized by white, milk curd-appearing plaques that are attached to the oral mucosa. Canker sores can appear as ulcers 0.5 to 2 cm in diameter on surfaces that are not attached to bone, such as the tongue, gums, or inner lining of the cheeks and lips. Cold sores (―fever blisters‖) are most commonly found at the junction of the mucous membrane and the skin of the lips or nostrils, although they can occur inside the mouth, especially affecting the gums and roof of the mouth. Mucositis is a general term used to describe a painful inflammation of the mucous membranes of the mouth.

DIF: Cognitive Level: Knowledge REF: p. 508 | p. 510 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Infection 3. Which primary pharmacologic therapy is used to treat Candida albicans? a. Steroids b. Antifungal agents c. Topical anesthetics d. Topical anti-inflammatory agents ANS: B

Candida albicans is the most common oral infection appearing in extremely debilitated patients. Medications that predispose a person to C. albicans infections are those that depress the immune system and those that cause xerostomia. Candida albicans is a fungus and therefore is treated with antifungal agents such as nystatin (Mycostatin). Steroids, topical anesthetics, and topical anti-inflammatory agents are not used to treat C. albicans.

DIF: Cognitive Level: Knowledge REF: p. 508 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Infection 4. Which condition is treated by saliva substitutes? a. Caries b. Mucositis c. Xerostomia d. Halitosis ANS: C

Xerostomia, or lack of saliva, originates from nonoral causes. Xerostomia is treated by discontinuing medications that dry the mucous membranes or by artificial saliva products.

Dentifrices are used to treat caries. Saliva substitutes are not used to treat mucositis.

Mouthwash is used to treat halitosis, along with dentifrices.

DIF: Cognitive Level: Knowledge REF: p. 509 | p. 510 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Nutrition 5. Which information will the nurse include when teaching a patient about cold sores? a. Use of drying agents prevents the spread of secretions. b. Erupted lesions are not contagious. c. Eruptions are related to breaks in personal hygiene. d. Pus-filled lesions indicate a secondary bacterial infection.

ANS: D

Cold sore lesions first become visible as small red papules that later develop into 1- to 3-mm diameter fluid-filled blisters. Over the following 10 to 14 days, a crust develops as the vesicles that burst coalesce into larger lesions. The liquid from the vesicles contains the live virus that can be transferred to other people by direct contact. The base of the lesions is erythematous. If pus develops in the vesicles or under the crust of a cold sore, a secondary bacterial infection may be present and the patient should seek medical attention. Drying agents are not used to treat cold sores. Cold sores are contagious. Eruptions are not necessarily related to poor personal hygiene.

DIF: Cognitive Level: Comprehension REF: p. 509 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Infection 6. Which local anesthetic is used for inflammation of oral mucous membranes? a. Chlorhexidine (Peridex) b. 2% viscous lidocaine c. Nystatin (Mycostatin) d. Hydrogen peroxide ANS: B

Two percent viscous lidocaine is used as a topical anesthetic for pain associated with oral inflammation. Care must be taken so that the patient does not accidentally burn himself or herself because the drug anesthetizes the entire mouth and throat. Chlorhexidine, nystatin, and hydrogen peroxide are not local anesthetics.

DIF: Cognitive Level: Knowledge REF: p. 510 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Inflammation

OBJ: 1 | 2

7. Which medication helps prevent or reduce mucositis in patients undergoing chemotherapy or

radiation treatment? a. Amlexanox paste (Aphthasol) b. Palifermin (Kepivance) c. Docosanol (Abreva) d. Nystatin (Mycostatin) ANS: B

Palifermin is a recombinant human keratinocyte growth factor approved specifically for preventing and treating the mucositis that develops in leukemia or lymphoma patients undergoing chemotherapy before bone marrow transplantation. Amlexanox paste is used to treat canker sores. Docosanol is used to treat cold sores. Nystatin is used to treat thrush.

DIF: Cognitive Level: Knowledge REF: p. 510 | p. 511 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Inflammation | Health Promotion 8. Which infection is often called the ―disease of the diseased‖ because it appears in debilitated

patients? a. Aspergillosis

b. Candidiasis c. Trichomoniasis d. Brucellosis ANS: B

Candidiasis is a fungal infection caused by C. albicans, the most common organism associated with oral infections. It is often called the ―disease of the diseased‖ because it appears in debilitated patients and patients taking a variety of medicines. Aspergillosis is caused by the fungus Aspergillus, which is commonly found growing on dead leaves, stored grain, or compost piles, or in other decaying vegetation. Although it is similar to candidiasis in its occurrence in debilitated patients, it is not as common. Trichomoniasis is a common parasitic sexually transmitted disease. Brucellosis is a zoonotic infection transmitted from animals to humans by the ingestion of infected food products, direct contact with an infected animal, or inhalation of aerosols.

DIF: Cognitive Level: Comprehension REF: p. 508 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Infection 9. Which cause is the most common associated to tooth, gum, and periodontal disease? a. Sugar b. Halitosis c. Plaque d. Smoking ANS: C

Plaque is the primary cause of most tooth, gum (gingiva), and periodontal disease. Plaque, the whitish yellow substance that builds up on teeth and gum lines, is thought to originate from saliva. Plaque forms a sticky meshwork that traps bacteria and food particles. If not removed regularly, it thickens, and bacteria proliferate. Sugar is not a cause of dental disease as such but becomes a problem when poor oral hygiene allows it to collect in the oral cavity. Halitosis is a symptom of poor oral hygiene but is not a cause of dental disease. Although smoking can contribute to periodontal disease through vasoconstriction, it is not a cause of dental disease.

DIF: Cognitive Level: Comprehension REF: p. 508 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Inflammation 10. Which instruction by the nurse is most important when educating a patient about using

viscous lidocaine (Xylocaine) for mucositis? a. ―Cleanse the oral cavity after using.‖ b. ―This medication can be used as a gargle.‖ c. ―After using, wait for 30 minutes before eating.‖ d. ―Your sense of taste will be diminished.‖ ANS: C

Caution the patient not to take food or drink for approximately 30 minutes after the medication because of the risk of aspiration from the absence of the gag reflex. The oral cavity is cleansed before administration. The medication can be used as a gargle and the sense of taste is diminished, but these are not the most important instructions.

DIF: Cognitive Level: Application

REF: p. 511

OBJ: 2

NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Inflammation | Safety | Patient Education 11. A patient is being treated with topical amlexanox paste 5% (Zilactin). Which statement by the

patient indicates a knowledge deficit? a. ―This medicine will help control discomfort.‖ b. ―I will apply the paste before meals.‖ c. ―The paste will be applied to each lesion.‖ d. ―Healing will be promoted.‖ ANS: B

It is best to apply amlexanox paste 5% (Zilactin) after meals. Discomfort is controlled with this medication; it is applied to each lesion and promotes healing.

DIF: Cognitive Level: Comprehension REF: p. 511 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety | Patient Education 12. Which treatment will the nurse encourage when a patient using carbamide peroxide

(Gly-Oxide) to treat multiple canker sores develops tissue irritation, a black hairy tongue and asks what can be done to soothe the pain? a. Milk of Magnesia b. Viscous lidocaine 2% c. Salivart d. Saline rinses ANS: D

Saline rinses may be soothing and can be used before topical application of carbamide peroxide (Gly-Oxide). They would be encouraged prior to other measures. Milk of Magnesia, viscous lidocaine 2%, and Salivart are not used to soothe this side effect.

DIF: Cognitive Level: Application REF: p. 510 | p. 511 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Inflammation | Patient Education 13. The nurse is assisting with care of a patient on chemotherapy with severe mucositis. The

patient reports mucous membrane pain level to be ―8‖ on the pain scale. Which priority nursing problem exists for this patient? a. Decreased nutrition b. Potential aspiration risk c. Dehydration d. Pain.

ANS: D

Pain is the nursing priority. A score of ―8‖ indicates severe pain and comfort measures would take priority. Altered nutrition: less than body requirements, risk for aspiration, and fluid volume deficit are not the priorities at this time.

DIF: Cognitive Level: Application REF: p. 510 OBJ: 2 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment | NCLEX Client Needs

Category: Physiological Integrity CON: Clinical Judgment | Pain

TOP: Nursing Process Step: Diagnosis

MULTIPLE RESPONSE 1. The nurse is completing education for a patient who will be undergoing chemotherapy next

week. Which information will the nurse include in the teaching plan in anticipation of adverse effects associated with oral mucositis resulting from chemotherapy? (Select all that apply.) a. Avoid acidic and spicy foods. b. Using docosanol (Abreva) will decrease the pain. c. Milk of Magnesia can be used to rinse the mouth and coat mucous membranes. d. Nystatin liquid can be taken orally to eliminate fungal infections. e. Cleanse the oral cavity before applying topical agents. f. Rinse the mouth with an over-the-counter (OTC) mouthwash.

ANS: A, C, D, E

Spicy and acidic foods should be avoided to prevent irritation to mucous membranes. Viscous lidocaine 2%, Milk of Magnesia, diluted bismuth subsalicylate (Kaopectate), and sucralfate suspensions may be used for topical application. Oral candidal infections are often adverse effects of chemotherapy, and nystatin liquid, an antifungal agent, may be prescribed.

Directions for using this agent include swishing the medication in the oral cavity for approximately 1 minute before swallowing or sucking on lozenges (troches) to reduce candidal oral infections. Pain medication applied topically must come into contact with mucous membranes to be effective. Therefore, it is advisable to clean the oral cavity before application. This medication is not used in the treatment of oral mucositis. OTC mouthwashes are usually not recommended for treatment of mucositis.

DIF: Cognitive Level: Comprehension REF: p. 510 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Inflammation | Safety | Patient Education 2. Which information will the nurse include when educating a 12-year-old patient about care of a

cold sore? (Select all that apply.) a. ―Keep the cold sore clean with mild soap.‖ b. ―Use an astringent to assist in drying the cold sore and promote rapid healing.‖ c. ―Keep the cold sore moist to prevent cracking.‖ d. ―Note signs of infection, including the presence of pus. Contact the healthcare provider if this occurs.‖ e. ―Oral analgesics may help alleviate pain.‖ ANS: A, C, D, E

To reduce the possibility of further infection with bacteria, the area should be kept clean.

Cold sores should be kept moist to prevent cracking and the development of secondary bacterial infection. With secondary infection, application of antibiotic ointment would be indicated. Application of docosanol, local anesthetics, and UV blockers or oral analgesics may be prescribed. Astringents should be avoided to prevent drying, delayed healing, and increased discomfort.

DIF: Cognitive Level: Comprehension REF: p. 511 NAT: NCLEX Client Needs Category: Physiological Integrity

OBJ: 1 | 2

TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Infection | Tissue Integrity | Patient Education 3. Which assessment information is pertinent to oral health? (Select all that apply.) a. Medication history b. Dental history, visit frequency c. Presence of halitosis d. Amount of saliva present e. Bowel sounds ANS: A, B, C, D

Pertinent history for oral health includes current drug therapy and dental history and frequency. Halitosis may indicate poor oral hygiene or the presence of infection in the oral cavity. Reduced amount of saliva is a risk factor for injury and infection in the oral cavity.

Bowel sounds are not pertinent information to oral health.

DIF: Cognitive Level: Comprehension REF: p. 510 | p. 511 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Health Promotion 4. Which treatment option(s) may promote comfort for a patient who is undergoing bone marrow

transplantation has developed severe mucositis? (Select all that apply.) a. 2% viscous lidocaine (Xylocaine) before meals b. Acetylcysteine (Mucomyst) therapy as needed c. Commercially prepared mouthwashes d. Docosanol (Abreva) therapy e. Milk of Magnesia mouth rinses ANS: A, E

The pain with mucositis can be extremely severe. Viscous lidocaine 2% anesthetizes the entire mouth and throat. Used before meals, it facilitates patient eating. Care must be taken that the patient does not burn himself or herself because sensation is diminished. Milk of Magnesia can also be used as a mouth rinse to coat the mucous membranes. Acetylcysteine does not treat mucositis. Commercial mouthwashes contain alcohol, which is detrimental to the healing of mucositis. Docosanol is used to treat topical herpes infections, not mucositis.

DIF: Cognitive Level: Comprehension REF: p. 510 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Inflammation | Pain | Patient Education 5. Which are adverse effects of xerostomia? (Select all that apply.) a. Reduced taste and appetite b. Excessive salivation c. Difficulty chewing and swallowing food d. Increase in dental caries e. Difficulty with speech f. Improved taste and enjoyment of food ANS: A, C, D, E

Xerostomia increases tooth decay and causes loss of taste, difficulty in chewing and swallowing food, and difficulty talking. Xerostomia does not cause excessive salivation or food to taste better.

DIF: Cognitive Level: Comprehension REF: p. 509 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Nutrition | Safety | Communication

OBJ: 1

Chapter 32: Drugs Used to Treat Gastroesophageal Reflux and Peptic Ulcer Disease Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which medication is used in the treatment of gastric reflux esophagitis and diabetic

gastroparesis? a. Metoclopramide b. Misoprostol c. Pantoprazole d. Ranitidine ANS: A

Metoclopramide is a gastric stimulant used to relieve the symptoms of gastric reflux esophagitis and diabetic gastroparesis, aid in small bowel intubation, and stimulate gastric emptying and intestinal transit of barium after radiologic examination of the upper gastrointestinal (GI) tract. Misoprostol is used to prevent and treat gastric ulcers caused by NSAIDs, including aspirin. Pantoprazole and ranitidine do not treat gastroparesis.

DIF: Cognitive Level: Comprehension REF: p. 526 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Inflammation | Nutrition

OBJ: 3

2. Which time is best to administer sucralfate qid? a. 1 hour before meals b. With meals c. 1 hour after meals d. With a bedtime snack ANS: A

This medication should be administered on an empty stomach. Taking the medication with meals, 1 hour after meals, or with a bedtime snack does not allow the medication to form its protective coat of the gastric mucosa.

DIF: Cognitive Level: Comprehension REF: p. 526 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Nutrition

OBJ: 3 | 4

3. Which adverse effect is common with magnesium-based antacid preparations? a. Heartburn b. Rebound indigestion

c. Constipation d. Diarrhea ANS: D

Magnesium oxide, magnesium hydroxide, and magnesium trisilicate are used in antacid preparations. All magnesium products can cause diarrhea. Milk of Magnesia is often taken for constipation. Antacids are given to relieve heartburn. Calcium-based antacids are likely to cause rebound indigestion. Magnesium is often given as a laxative, in antacid form or as magnesium sulfate.

DIF: Cognitive Level: Knowledge REF: p. 520 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Elimination | Fluid and Electrolytes 4. Which class of drug is cimetidine (Tagamet)? a. Protokinetic agent b. Proton pump inhibitor c. Histamine (H2) receptor antagonist d. Coating agent ANS: C

All H2 receptor antagonists end in ―dine.‖ Examples in this category include cimetidine, ranitidine, famotidine, and nizatidine. An example of a protokinetic agent is metoclopramide.

An example of a proton pump inhibitor is omeprazole. An example of a coating agent is sucralfate.

DIF: Cognitive Level: Knowledge REF: p. 522 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 3 CON: Clinical Judgment

5. A postoperative appendectomy patient has a nasogastric tube and wonders why the previous

nurse told him that he was receiving an IV ―ulcer-preventing‖ medication called ranitidine.

The patient states that he has never had any stomach problems in his life. Which response is best by the nurse? a. ―This medication will cause the pH in your stomach to drop.‖ b. ―This medication helps coat your stomach while the nasogastric tube is in place.‖ c. ―Because you are not eating after surgery, this medication will help reduce the hydrochloric acid your stomach is still secreting.‖ d. ―The nasogastric tube will cause peptic ulcer disease. This medication will help prevent that.‖ ANS: C

Patients who are not eating still secrete hydrochloric acid from the stomach‘s parietal cells. H2 receptor antagonists block the H2 receptors, resulting in a decrease in the amount of acid secreted. The pH of the stomach contents then becomes less acidic, which reduces the stress of the mucosal lining of the stomach. Ranitidine causes the stomach contents to become less acidic as the amount of acid secreted decreases; consequently, the pH of the stomach rises.

This is not a coating agent, and giving it parenterally will not work to coat the stomach.

Increased gastric acid, not nasogastric tubes, causes peptic ulcer disease (PUD).

DIF: Cognitive Level: Application

REF: p. 521

OBJ: 2 | 4

NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Health Promotion 6. Which explanation by the nurse is accurate to include when teaching a patient who is

beginning therapy for gastroesophageal reflux disease (GERD) with metoclopramide? a. ―This medication decreases esophageal muscle tone to reduce reflux.‖ b. ―Peristalsis is increased, so food is digested more quickly.‖ c. ―Gastric emptying is delayed, so you may feel full for longer intervals.‖ d. ―This medication is an antikinetic agent, so you may have difficulty with motor skills.‖ ANS: B

Prokinetic agents increase the lower esophageal sphincter muscle pressure and peristalsis, hastening emptying of the stomach to reduce reflux. Metoclopramide increases lower esophageal sphincter pressure. Metoclopramide hastens gastric emptying. Metoclopramide is a prokinetic agent and does not affect motor function.

DIF: Cognitive Level: Comprehension REF: p. 526 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Planning CON: Clinical Judgment | Patient Education | Nutrition 7. Which explanation by the nurse is accurate when a patient who is taking NSAIDs to treat

arthritis asks why misoprostol has also been prescribed? a. NSAIDs often cause GI irritation that can result in peptic ulcers. b. NSAIDs promote the production of prostaglandins and reduce the incidence of gastric irritation. c. Antiulcer medications eradicate the presence of bacteria in the stomach that cause ulcers. d. Drug interactions are prevented when antiulcer medications are used in combination with NSAIDs. ANS: A

Misoprostol, a GI prostaglandin, is used to prevent and treat gastric ulcers caused by NSAIDs. Prostaglandin inhibition is effective in reducing pain and inflammation, especially in arthritis, but makes the patient more predisposed to peptic ulcers. Prostaglandins are normally present in the GI tract to inhibit gastric acid and pepsin secretion to protect the stomach and duodenal lining against ulceration. NSAIDs inhibit prostaglandin production. Bismuth subsalicylate, metronidazole, and tetracycline combination (Helidac), as well as lansoprazole, clarithromycin, and amoxicillin combination (Prevpac), are used to treat infections caused by Helicobacter pylori. Drug interactions are not prevented by the presence of antiulcer medications.

DIF: Cognitive Level: Comprehension REF: p. 523 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Patient Education 8. Which organism or disorder is responsible for many cases of PUD? a. H. pylori b. Candida albicans c. Escherichia coli

d. Herpes zoster ANS: A

Various combinations of antibiotics (e.g., amoxicillin, tetracycline, metronidazole, clarithromycin), bismuth, and antisecretory agents (e.g., H2 antagonists, proton pump inhibitors) are used to eradicate H. pylori. Candida albicans is the causative agent of candidiasis. Escherichia coli is a normal bowel flora. Herpes zoster is also known as shingles.

DIF: Cognitive Level: Knowledge REF: p. 518 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 | 2 CON: Clinical Judgment

9. Which explanation by the nurse is accurate when a patient diagnosed with PUD asks the nurse

about the action of prokinetic medications? a. Blocks the formation of hydrochloric acid, reducing irritation of the gastric mucosa. b. Increases the lower esophageal sphincter muscle pressure and peristalsis. c. Reduces the secretion of saliva, hydrochloric acid, pepsin, bile, and other enzymatic fluids. d. Decreases the volume of hydrochloric acid produced, increasing the gastric pH. ANS: B

Prokinetic agents increase the lower esophageal sphincter muscle pressure and peristalsis, hastening emptying of the stomach to reduce reflux. Proton pump inhibitors block the formation of hydrochloric acid, reducing irritation of the gastric mucosa. Antispasmodic agents reduce the secretion of saliva, hydrochloric acid, pepsin, bile, and other enzymatic fluids necessary for digestion and decrease GI motility and secretions. H2 antagonists decrease the volume of hydrochloric acid produced, increasing the gastric pH, which results in decreased irritation to the gastric mucosa.

DIF: Cognitive Level: Comprehension REF: p. 518 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 3 | 4

10. Which time frame is considered acceptable for a patient with gastric distress to self-medicate

with over-the-counter antacids? a. Hours b. Days c. Weeks d. Months ANS: C

For indigestion, antacids should not be administered for more than 2 weeks. If after this time the patient is still experiencing discomfort, a healthcare provider should be contacted. A time frame of hours or days is less than the acceptable time interval. A time frame of months is greater than the acceptable time interval.

DIF: Cognitive Level: Comprehension REF: p. 520 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety

11. The nurse is instructing a patient recently diagnosed with GERD. Which statement by the

patient indicates a need for further teaching? a. ―I will avoid foods high in fat.‖ b. ―I will eat small frequent meals and have a snack at bedtime.‖ c. ―Orange juice may aggravate my symptoms.‖ d. ―I will wait 2 hours after eating lunch before lying down for a nap.‖ ANS: B

Late-night snacks need to be avoided to reduce increased gastric secretions. The patient with GERD needs to avoid foods high in fat and should wait 2 hours after eating before lying down. Orange juice may aggravate the symptoms of a patient with GERD. DIF: Cognitive Level: Comprehension REF: p. 519 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Patient Education | Health Promotion 12. The nurse is planning to administer an antacid to a patient diagnosed with PUD who will

receive an H2 antagonist at 8:00 AM. Which time is most appropriate for the nurse to provide the antacid to this patient? a. With the H2 antagonist b. 30 minutes prior to the H2 antagonist c. 2 hours after the H2 antagonist d. Within an hour after the H2 antagonist ANS: C

Because antacid therapy is often continued during early therapy of PUD, administer 1 hour before or 2 hours after H2 antagonist dose.

DIF: Cognitive Level: Application REF: p. 519 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 4 CON: Clinical Judgment | Safety

13. Which action should be encouraged for a patient taking misoprostol (Cytotec) to treat a gastric

ulcer reports recurrent diarrhea? a. Immediately discontinue misoprostol (Cytotec). b. Take with a magnesium-containing antacid. c. Omit fresh fruits from diet. d. Take medication with meals.

ANS: D

Taking medication with meals may lessen diarrhea. Diarrhea associated with misoprostol therapy is dose related. The patient should not discontinue therapy without first consulting with the healthcare provider. Magnesium-containing antacids should be avoided. Fresh fruits are considered roughage and should be encouraged.

DIF: Cognitive Level: Application REF: p. 523 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 4

MULTIPLE RESPONSE 1. Which factor(s) prevent(s) breakdown of the body‘s normal defense barriers that protect

against ulcer formation? (Select all that apply.) a. Stomach pH b. Prostaglandins c. Intrinsic factor d. Mucous cells e. Hydrochloric acid ANS: B, D

Prostaglandins play a major role in protecting the stomach walls from injury by stomach acids and enzymes. They inhibit gastric acid secretion, maintain blood flow, and stimulate mucus and bicarbonate production. Mucous cells secrete mucus that coats the stomach wall and protects the stomach wall from hydrochloric acid and the digestive enzyme pepsin. For decades, ulcer treatment focused on reducing acid secretions (anticholinergic agents, H2 antagonists, proton pump inhibitors), neutralizing acid (antacids), or coating ulcer craters to hasten healing (sucralfate). Major changes in therapy have come about because the FDA has approved antibiotics to eradicate H. pylori. Intrinsic factor is a glycoprotein secreted by parietal cells of the gastric mucosa. It has an important role in the absorption of vitamin B12 (cobalamin) in the intestine, and failure to produce or use intrinsic factor results in the condition termed pernicious anemia.

DIF: Cognitive Level: Comprehension REF: p. 516 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 2 CON: Clinical Judgment

2. Which are important nursing considerations when administering prokinetic agents? (Select all

that apply.) a. These agents are used to treat esophagitis associated with gastric reflux. b. They are used to treat GERD when lifestyle changes and diet are ineffective. c. They may be useful in treating nausea associated with chemotherapy treatment. d. They may be administered intravenously. e. Administer the medication to diabetic patients after meals.

ANS: A, B, C, D

Metoclopramide is used to relieve the symptoms of gastric reflux esophagitis. This agent is used to treat GERD when lifestyle and diet modifications are ineffective. Metoclopramide is used as an antiemetic in conjunction with chemotherapy. Prokinetic agents may be administered intravenously and should be administered before meals.

DIF: Cognitive Level: Comprehension REF: p. 518 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 3. Which factor(s) contribute(s) to the development of PUD? (Select all that apply.) a. Cigarette smoking b. Stress c. Genetics d. Excessive ingestion of milk products e. H. pylori

ANS: A, C, E

Cigarette smoking increases acid secretion and alters blood flow to the stomach. In addition, cigarette smoking interferes with prostaglandin synthesis, which compromises defense mechanisms. A genetic predisposition seems to exist for the development of PUD. Infection

by H. pylori is thought to be associated with as many as 90% of duodenal and 70% of gastric ulcers. Chronic emotional stress was previously believed to cause stress ulcers, and physicians suggested that patients with this condition reduce their stress levels. However, patients who took steps to reduce the stress in their lives saw no improvement. It is now known that emotional stress does not cause ulcers, but it may make them worse. Bacteria have been shown to cause a stress ulcer, which can be treated simply by taking a dose of antibiotics.

Dairy products do not contribute to the development of ulcers.

DIF: Cognitive Level: Comprehension REF: p. 517 OBJ: 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment 4. Which drug therapy is aimed at reducing gastric acid secretions? (Select all that apply.) a. Prokinetic agents b. Antacids c. H2 antagonists d. Proton pump inhibitors e. Coating agents ANS: C, D

H2 antagonists and proton pump inhibitors are used to reduce gastric acid secretion. Prokinetic agents are used to hasten emptying of the stomach to reduce reflux. Antacids neutralize gastric acid. Coating agents are given to form a barrier in the stomach.

DIF: Cognitive Level: Comprehension REF: p. 518 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment 5. Which information will the nurse include when teaching a patient with renal failure about

antacid therapy for treatment of heartburn? (Select all that apply.) a. Taking magnesium-based antacids prevents diarrhea. b. Magnesium-based antacids are preferred for patients with renal failure. c. Aluminum hydroxide antacids exacerbate constipation. d. If the patient has coffee-ground emesis or bloody stools, the frequency of antacids should be doubled. e. Antacids neutralize gastric acid.

ANS: C, E

Constipation is an adverse effect of aluminum-based antacids. Antacids lower the acidity of gastric secretions by neutralizing the acid. Magnesium has a laxative effect. Patients with renal failure should not use antacids containing magnesium. Hematemesis or hematochezia should be reported to the healthcare provider immediately.

DIF: Cognitive Level: Comprehension REF: p. 519 | p. 520 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Elimination | Nutrition

6. Which information will be included when reviewing necessary dietary modifications and

lifestyle changes with a patient diagnosed with GERD? (Select all that apply.) a. Regarding limiting coffee intake to 2 cups/day b. Regarding smoking cessation c. Regarding avoiding NSAIDs d. Regarding decreasing protein foods e. Regarding using nonfat milk ANS: B, C, E

Interventions to help relieve symptoms associated with GERD include cessation of smoking, avoidance of NSAIDs, and use of nonfat milk. Coffee should be avoided completely. Protein foods should be increased.

DIF: Cognitive Level: Comprehension REF: p. 519 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Health Promotion | Nutrition

Chapter 33: Drugs Used to Treat Nausea and Vomiting Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. A patient is beginning the second round of high-dose cisplatin. Severe, chemotherapy-induced

nausea and vomiting (CINV) occurred following the first treatment, requiring 72 hours of continuous IV hydration. Which medication would be best to administer in addition to the chemotherapy regimen? a. Prochlorperazine (Compazine) suppository daily, on the day of treatment and the next 3 days b. Anticholinergic agents, such as diphenhydramine or meclizine c. Parenteral ondansetron 1 hour before chemotherapy, with oral ondansetron to continue for the next 4 days d. Parenteral ondansetron during chemotherapy, with prochlorperazine suppositories daily for 1 week ANS: C

With the patient‘s first treatment history and the emetogenic chemotherapy agent, cisplatin, ondansetron has shown to be the most effective for prevention of severe nausea and vomiting.

Prochlorperazine and anticholinergic agents are not used for the treatment of CINV. The ondansetron should be administered 1 hour before the chemotherapy and continued for the next several days to prevent vomiting and dehydration associated with chemotherapy administration.

DIF: Cognitive Level: Application REF: p. 538 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Fluid and Electrolytes

OBJ: 2 | 3

2. Which medication is most effective in preventing motion sickness? a. Serotonin antagonists

b. Phenothiazines c. Corticosteroids d. Anticholinergics ANS: D

Anticholinergic agents are used to treat motion sickness by counterbalancing the excessive amounts of acetylcholine present. Serotonin antagonists are used in the treatment of emesis associated with cancer chemotherapy, radiation therapy, and postoperative nausea and vomiting. Phenothiazines are used in the treatment of mild to moderate nausea and vomiting associated with anesthesia and surgery, radiation therapy, and cancer chemotherapy.

Corticosteroids are used in the treatment of nausea and vomiting related to pregnancy, postsurgical state, chemotherapy, radiation, and bowel obstruction.

DIF: Cognitive Level: Knowledge REF: p. 538 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Health Promotion

OBJ: 1 | 3

3. Which rationale explains the purpose for the nurse administering metoclopramide (Reglan) IV

postoperatively? a. Prolong the effects of anesthesia. b. Decrease the potential for thrombus formation. c. Prevent postoperative nausea and vomiting. d. Decrease postoperative pain.

ANS: C

Metoclopramide (Reglan) is an antiemetic and antagonist of dopamine and serotonin receptors. In addition to acting on receptor sites in the brain, metoclopramide increases sphincter tone in the gastrointestinal tract, which reduces nausea and vomiting.

Metoclopramide does not affect anesthesia or the vascular system and does not have analgesic effects.

DIF: Cognitive Level: Comprehension REF: p. 533 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Health Promotion 4. The nurse is assessing a patient with nausea and vomiting. Which additional autonomic

symptoms that often accompany vomiting will the nurse observe? a. Bradycardia, diarrhea, and flushing b. Pallor, sweating, and tachycardia c. Urinary urgency, chills, and dizziness d. Fever, hyperventilation, and bradycardia ANS: B

Autonomic symptoms of pallor, sweating, and tachycardia cause additional discomfort associated with vomiting. Bradycardia, diarrhea, flushing, urinary urgency, chills, dizziness, fever, and hyperventilation are not autonomic symptoms associated with vomiting.

DIF: Cognitive Level: Knowledge REF: p. 530 OBJ: N/A NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety

5. Which drug would the nurse expect to administer when treating hyperemesis gravidarum? a. THC (Marinol) b. Haloperidol (Haldol) c. Dexamethasone (Prednisone) d. Metoclopramide (Reglan) ANS: D

Metoclopramide is the drug of choice when treating hyperemesis gravidarum because no teratogenic effects have been reported with the use of this drug. THC is used in the treatment of nausea and vomiting associated with cancer and cancer treatment. Haloperidol is used in the treatment of nausea associated with chemotherapy. Prednisone is used in the treatment of nausea associated with pregnancy, postsurgical state, chemotherapy, radiation, and bowel obstruction.

DIF: Cognitive Level: Knowledge REF: p. 532 OBJ: 1 | 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety 6. Which reason explains why the nurse monitors daily weights prior to the administration of

antiemetic medications to chemotherapy patients? a. Antiemetics are calculated according to body surface area. b. Antiemetics are toxic, and the minimal dosage should be administered. c. Weight loss is a common adverse effect associated with chemotherapy, and dosages may need to be readjusted. d. Fluid overload is common, and antiemetic dosages are increased as treatment progresses.

ANS: C

Patients receiving chemotherapy are prone to weight loss resulting from nausea and vomiting.

As with any drug therapy, the safe dosage per weight parameters should be assessed daily to avoid potential overmedication when patients are losing significant weight. Antiemetics are not calculated according to body surface area. Antiemetics are not toxic in recommended dosages. Fluid overload is unrelated to antiemetic therapy.

DIF: Cognitive Level: Comprehension REF: p. 534 OBJ: 2 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Nutrition | Safety 7. Which advantage explains the reason for using benzodiazepines as an adjunctive treatment for

nausea and vomiting associated with chemotherapy? a. The long half-life will prolong the effectiveness of other drugs. b. They increase a sense of euphoria. c. The patient will not develop tolerance to the medications as quickly. d. The antianxiety effect helps, in addition to reducing the frequency of nausea and vomiting.

ANS: D

Benzodiazepines (e.g., diazepam, lorazepam, midazolam) are effective in reducing not only the frequency of nausea and vomiting but also the anxiety often associated with chemotherapy. Benzodiazepines do not affect the effectiveness of other drugs. Although distraction can be an effective intervention, using benzodiazepines is not a method to achieve this goal. Tolerance to benzodiazepines can develop quickly; they do not affect the development of tolerance to other drugs.

DIF: Cognitive Level: Comprehension REF: p. 543 | p. 544 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Anxiety 8. Which condition is occurring when a patient experiences nausea immediately on entering the

clinic to receive another course of chemotherapy? a. Psychogenic b. Chemotherapy induced c. Hyperemesis gravidarum d. Anticipatory nausea and vomiting ANS: D

Anticipatory nausea and vomiting is a conditioned response triggered by the sight or smell of the clinic or hospital or by the knowledge that treatment is imminent. Delayed reaction from a previous treatment would have occurred in a shorter interval after the other treatment. Delayed emesis occurs 24 to 120 hours after the administration of chemotherapy. Although smells can trigger nausea, this is not likely the cause of this patient‘s sickness. Hyperemesis gravidarum is excessive vomiting and nausea associated with pregnancy.

DIF: Cognitive Level: Comprehension REF: p. 532 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Anxiety | Mood and Affect 9. Which herb has been used in many cultures to provide relief of nausea associated with

pregnancy? a. Mint b. Hyssop c. Echinacea d. Ginger ANS: D

Ginger is an herb used in many cultures to treat pregnancy-induced nausea and vomiting. Mint is often used to treat mild dyspepsia. Hyssop is used as an expectorant and anticatarrhal.

Echinacea is used to boost the immune system.

DIF: Cognitive Level: Knowledge REF: p. 534 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 CON: Clinical Judgment | Nutrition

10. Which consideration will the nurse take into account when caring for a 27-year-old patient

taking a cannabinoid during chemotherapy? a. Antihistamines may potentiate the effects. b. Monitor the patient for fluid volume excess. c. Previous use of marijuana requires increased dosage.

d. Inform the patient to avoid the intake of potassium.

ANS: A

Antihistamines, alcohol, analgesics, benzodiazepines, barbiturates, antidepressants, muscle relaxants, and sedative hypnotics increase toxic effects. Fluid volume excess is not an adverse effect of cannabinoids. Previous use does not necessarily require increased dosage. There are no dietary restrictions with the use of cannabinoids.

DIF: Cognitive Level: Comprehension REF: p. 546 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Fluid and Electrolytes | Safety

OBJ: 2

11. The recovery room nurse is preparing to assist with the care of several postoperative patients.

Which patient would the nurse prioritize care for regarding the potential for postoperative nausea and vomiting (PONV)? a. A 5-year-old child undergoing a closed reduction procedure with regional anesthesia b. A 50-year-old woman undergoing a total hysterectomy with general anesthesia c. A 27-year-old man undergoing a middle ear manipulation with general anesthesia d. An 80-year-old man undergoing a total hip replacement with spinal anesthesia ANS: B

Women have a higher incidence of PONV, possibly because of hormonal differences. Patients who have had general anesthesia have a higher incidence of PONV than those who have had regional anesthesia. Children ages 11 to 14 years have the highest incidence of PONV based on age-group. Spinal anesthesia is generally least emetogenic.

DIF: Cognitive Level: Analysis REF: p. 533 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 12. Which medication puts a patient at the lowest risk of having an adverse reaction? a. Ondansetron b. Scopolamine c. Promethazine d. Dexamethasone ANS: D

Dexamethasone is a corticosteroid. A particular advantage of the steroids, apart from their efficacy, is their relative lack of adverse effects. Ondansetron, scopolamine, and promethazine have more associated side effects than dexamethasone.

DIF: Cognitive Level: Comprehension REF: p. 543 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety MULTIPLE RESPONSE 1. Which role(s) apply(ies) to the chemoreceptor trigger zone (CTZ) in vomiting? (Select all that

apply.)

a. b. c. d.

Initiates or induces vomiting.

Coordinates the vomiting reflex.

Activates the vomit center (VC) to induce vomiting.

Samples blood and spinal fluid for potentially toxic substances.

ANS: C, D

The CTZ stimulates the VC to induce vomiting as well as samples blood and spinal fluid for potentially toxic substances. The CTZ does not initiate vomiting or coordinate the vomiting reflex.

DIF: Cognitive Level: Comprehension REF: p. 530 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment 2. Which explanation(s) describe(s) why drug therapy is important for selected causes of nausea

and vomiting? (Select all that apply.) a. Relieves the distress associated with nausea and vomiting. b. Prevents aspiration of gastric contents into the lung. c. Prevents dehydration. d. Prevents electrolyte imbalances. e. Increases intracranial pressure.

ANS: A, B, C, D

Promoting comfort is a goal of treating nausea and vomiting. Aspiration can lead to severe respiratory complications. Dehydration is a common consequence of vomiting and can cause disturbances in electrolyte balances. Electrolytes are salts that the body needs to function well and stay healthy. Drugs that control nausea and vomiting do not increase intracranial pressure.

DIF: Cognitive Level: Comprehension REF: p. 533 OBJ: 1 | 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Fluid and Electrolytes 3. A patient going on vacation asks the nurse what can given to a 3-year-old child who becomes

car sick. Which response(s) would be accurate? (Select all that apply.) a. ―Positioning techniques such as placing the child facing forward and blocking out scenery through the side windows can be helpful.‖ b. ―There is no such thing as car sickness.‖ c. ―If your child does vomit, give over-the-counter Benadryl.‖ d. ―I would check with the pharmacist regarding over-the-counter products available for young children.‖ ANS: A, D

Positioning techniques that help block out the rapid peripheral movement assist young children who suffer from motion sickness. Over-the-counter products are available to medicate a young child. A healthcare provider should recommend dosages and evaluate other medications being currently given. Motion sickness is very real, and dismissing a patient‘s complaints is unprofessional. Benadryl is not effective for treating nausea or vomiting.

DIF: Cognitive Level: Comprehension REF: p. 533 | p. 534 OBJ: 1 | 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Health Promotion | Safety

4. A prepared childbirth nurse educator is discussing potential discomforts during pregnancy

with a group of women. Which statement(s) will be included when relaying information about nausea and vomiting? (Select all that apply.) a. The majority of pregnant women experience nausea and vomiting. b. Severe, persistent vomiting during pregnancy is known as anticipatory vomiting. c. Vomiting during pregnancy is more common among primigravidas. d. Prior fetal loss puts a woman at higher risk. e. Nausea and vomiting during pregnancy can occur at any time of the day.

ANS: C, E

Vomiting during pregnancy is more common among primigravidas. Nausea and vomiting during pregnancy can occur at any time of the day. The percentage of women reporting vomiting during the first 16 weeks of gestation is relatively constant at about 40%, decreasing to 20% from 17 to 20 weeks. Only 9% of women report vomiting after 20 weeks of pregnancy. Severe, persistent vomiting during pregnancy is known as hyperemesis gravidarum. Contrary to commonly held beliefs, vomiting is not more common in women who have experienced prior fetal losses.

DIF: Cognitive Level: Comprehension REF: p. 532 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

Chapter 34: Drugs Used to Treat Constipation and Diarrhea Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which example best identifies normal bowel elimination? a. Daily bowel movements b. Multiple soft stools daily c. Daily liquid stools d. Regular bowel elimination pattern of soft stool ANS: D

Normal bowel habits are stools that are soft and occur on a regular schedule of elimination for that particular patient. Although this may be routine for some people, it is not normal for everyone. Liquid stools are not considered normal.

DIF: Cognitive Level: Comprehension REF: p. 550 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Elimination 2. Which drug would be most effective for an obstetric patient who is complaining of

constipation as a result of her enlarging uterus and use of prenatal vitamins? a. Saline laxative b. Lubricant laxative c. Stimulant laxative d. Mineral oil ANS: B

Lubricant and bulk-forming laxatives may be used in the pregnant patient because little cramping accompanies their use. Saline laxatives are not safe for a pregnant woman because of the bowel distention and possible electrolyte imbalance they may cause. Stimulant laxatives are too harsh for a pregnant woman because they may cause cramping. Mineral oil is not a good laxative to use on a regular basis because it can cause malabsorption of vitamins.

DIF: Cognitive Level: Comprehension REF: p. 555 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Elimination

OBJ: 1

3. Which patient would use of a laxative be contraindicated? a. Patient with quadriplegia b. Patient with appendicitis c. Geriatric patient d. Patient with fractured femur ANS: B

Patients who have a history of an inflammation of the gastrointestinal (GI) tract, including gastritis, colitis, Crohn‘s disease, ulcerative colitis, and appendicitis, should not take laxatives and should be referred to a healthcare provider. Quadriplegic and geriatric patients as well as patients with fractures may generally take laxatives and stool softeners on a regular basis.

DIF: Cognitive Level: Application REF: p. 555 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Elimination 4. Which type of laxative is the best choice for an older patient who is in the end stage of

Alzheimer‘s disease and requires a daily laxative? a. Emollient b. Stimulant c. Fecal softener d. Bulk forming ANS: D

Bulk-forming laxatives are considered the safest laxative for routine use because they cause water to be retained within the stool, which increases bulk, and stimulates peristalsis.

Emollient laxatives reduce muscle tone and decrease peristalsis over time. Stimulant laxatives can cause cramping and should not be used on a regular basis. Fecal softeners are not laxatives.

DIF: Cognitive Level: Comprehension REF: p. 555 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety | Elimination 5. Which is the nurse‘s best response when a friend reports using loperamide (Imodium) for

continual diarrhea for a week since returning home from a vacation outside the country? a. ―There are some other over-the-counter products available for diarrhea, such as Kaopectate (bismuth subsalicylate).‖ b. ―I‘d stop taking the Imodium and go in to see a healthcare provider immediately.

You may have an infection in your intestinal tract.‖

c. ―If you‘re not running a temperature, I wouldn‘t worry. That happens to many

people when they travel.‖ d. ―As long as you can drink plenty of fluids, I‘m sure the diarrhea will go away once

you‘re back in a normal routine.‖ ANS: B

Diarrhea may be a defense mechanism to rid the body of infecting organisms or irritants.

Diarrhea is usually self-limiting and should not be suppressed with over-the-counter products.

It is safest for people who are suffering from diarrhea after traveling outside the country to visit their healthcare provider, who can determine whether an infection is present.

DIF: Cognitive Level: Application REF: p. 557 OBJ: 2 | 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Patient Education | Safety | Communication | Elimination | Infection 6. Which medication would be prescribed to a patient who has had a myocardial infarction is

advised to avoid straining with defecation? a. Stool softeners b. Bulk-forming laxatives c. Stimulants d. Emollients ANS: A

Stool softeners are routinely used for the prevention of constipation or to prevent straining with defecation (e.g., in patients recovering from myocardial infarction or abdominal surgery).

Bulk-forming laxatives and emollients can cause straining. Stimulants can cause cramping and straining.

DIF: Cognitive Level: Comprehension REF: p. 555 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety 7. An older adult is admitted through the emergency department with complaints of nausea,

abdominal tenderness, and continual stooling. On assessment, the nurse notes abdominal distention, smearing of stool on undergarments, and hypoactive bowel sounds LUQ and LLQ. The patient is unable to determine when the last bowel movement was. Which assessment is the nurse‘s priority? a. Signs and symptoms of an infection b. An impaction c. A pattern of laxative abuse d. History of GI disease ANS: B

A nursing priority is to determine basic needs such as last bowel movement, constipation, and pain control. The symptoms presented do not indicate an infection as a priority. Frequent stooling indicated by the history and smearing on the undergarments are signs of an impaction, or an area of hardened stool. Laxative abuse or a history of GI disease may be contributing factors that the healthcare provider will review. Although the patient may have an infection or history of GI disease, checking for an impaction is a higher priority because it is done more quickly and is more likely to yield results. These symptoms are not characteristic of laxative abuse.

DIF: Cognitive Level: Application REF: p. 556 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Elimination 8. Which symptom is the patient with a lactase deficiency most likely to exhibit? a. Constipation b. Excessive salivation c. Diarrhea d. Vomiting ANS: C

Patients with deficiencies of digestive enzymes such as lactase or amylase have difficulty digesting certain foods. Diarrhea usually develops because of irritation from undigested food.

Constipation, excessive salivation, and vomiting do not result from enzyme deficiencies.

DIF: Cognitive Level: Comprehension REF: p. 551 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Elimination 9. A patient is receiving morphine for pain control. Which patient education information will the

nurse emphasize about preventing constipation? a. Adequate hydration consists of four full glasses of water every day. b. Laxatives should be given on a daily basis. c. Stool softeners are taken on a regular basis during opioid use. d. Enemas should be given on a weekly basis.

ANS: C

When codeine or morphine is used regularly for pain control in cancer patients, it is imperative that the individual know that stool softeners should be initiated and continued as long as constipating medicines are being taken. Although adequate hydration is important in the prevention of constipation, individual needs vary, and hydration alone cannot prevent constipation related to opioid use. Laxatives are too harsh to be given regularly unless specifically ordered by the healthcare provider. Enemas are not a preventive measure but an intervention intended to produce a more positive outcome.

DIF: Cognitive Level: Comprehension REF: p. 553 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Elimination | Pain | Patient Education | Safety 10. Which explanation accurately describes the mechanism of action of a stimulant laxative? a. Draws water into the bowel to facilitate the passage of feces.

b. Lubricates the intestinal wall and softens stool. c. Increases bulk and stimulates peristalsis. d. Irritates the intestine directly, promoting peristalsis and evacuation.

ANS: D

Stimulant laxatives act directly on the intestine, causing an irritation that promotes peristalsis and evacuation. Saline laxatives draw water into the bowel to facilitate the passage of feces.

Lubricant laxatives lubricate the intestinal wall and soften the stool, allowing a smooth passage of fecal contents. Bulk-producing laxatives must be administered with a full glass of water. The laxative causes water to be retained within the stool. This increases bulk, which stimulates peristalsis.

DIF: Cognitive Level: Knowledge REF: p. 553 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Elimination 11. Which effect will the nurse expect when a patient is taking psyllium while on digoxin? a. Decreased effectiveness of the laxative b. Increased laxative effect c. Increased absorption of the digoxin d. Decreased absorption of the digoxin ANS: D

Do not administer products containing psyllium (e.g., Metamucil) at the same time as salicylates, nitrofurantoin, or digoxin glycosides. The psyllium may inhibit absorption.

Administer these medications at least 1 hour before or 2 hours after psyllium. Digoxin does not affect laxatives.

DIF: Cognitive Level: Comprehension REF: p. 556 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Elimination

OBJ: N/A

12. Which instruction will the nurse include in the discharge teaching of a patient taking

psyllium? a. ―Administer with a full glass of water.‖ b. ―Limit the intake of high-fiber foods.‖ c. ―Avoid mixing in juice.‖ d. ―Fat-soluble vitamin deficiency is common.‖ ANS: A

It is important that bulk-forming laxatives be dispersed in a full glass of water or juice before administration. High-fiber foods should not be limited. Psyllium may be mixed in juice for administration. Fat-soluble vitamin deficiency is not a common adverse effect.

DIF: Cognitive Level: Application REF: p. 555 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Elimination | Patient Education | Safety 13. Which instruction by the nurse will assist in the patient‘s understanding of lactulose, an

osmotic laxative?

a. b. c. d.

―This medication draws water into the intestine and stimulates defecation.‖ ―There is increased irritability directly on the intestinal wall.‖ ―There is lubrication of the intestinal wall that softens the stool.‖ ―There is an effect on the nerves to increase the peristalsis of the intestinal smooth muscle.‖

ANS: A

Osmotic laxatives (e.g., magnesium hydroxide, magnesium sulfate, magnesium citrate, sodium phosphate, lactulose, polyethylene glycol) are hypertonic compounds that draw water into the intestine from surrounding tissues.

DIF: Cognitive Level: Application REF: p. 553 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Elimination

OBJ: 1

14. The nurse is caring for a patient receiving palliative care with opioid-induced constipation.

Laxative therapy has been unsuccessful in treating this patient. Which PRN medication should the nurse provide to best alleviate this type of constipation? a. Methylnaltrexone b. Bisacodyl c. Mineral oil d. Docusate ANS: A

Methylnaltrexone is used for the treatment of opioid-induced constipation in patients with advanced illness who are receiving palliative care when their response to laxative therapy has not been adequate. Bisacodyl, mineral oil, and docusate are not the treatment of choice for this situation.

DIF: Cognitive Level: Application REF: p. 555 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Elimination

OBJ: 1

15. The nurse is assessing a patient taking lactulose to treat chronic constipation. Which adverse

effect should the nurse immediately report to the healthcare provider? a. Nausea b. Abdominal spasms c. Flatulence d. Abdominal tenderness ANS: D

Abdominal tenderness is considered a serious adverse effect and can indicate acute abdomen.

Nausea, abdominal spasms, and flatulence are common adverse effects.

DIF: Cognitive Level: Application REF: p. 556 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Elimination MULTIPLE RESPONSE

1. Which situation(s) would cause constipation? (Select all that apply.) a. Diet low in fiber and/or residue b. Excessive fluid intake c. Diet low in cheese and yogurt d. Iron supplements e. Use of morphine ANS: A, D, E

Constipation can be caused by diets lacking in adequate residue and/or fiber and fluids or the use of constipating medicines (morphine, codeine, and anticholinergic agents). Iron has a constipating effect. Fluid intake helps prevent constipation. Constipation can be caused by excessive intake of constipating foods such as cheese or yogurt.

DIF: Cognitive Level: Comprehension REF: p. 550 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Elimination 2. Which sign(s) and symptom(s) is/are consistent with dehydration? (Select all that apply.) a. Increased hemoglobin and hematocrit b. Decreased urine specific gravity c. Mental confusion and excessive thirst d. Periorbital edema and increased blood pressure e. Nonelastic skin turgor and delayed capillary filling ANS: A, C, E

Blood work of dehydrated patients will show falsely elevated hemoglobin and hematocrit levels as a result of decreased capillary fluid. Dehydrated patients may become confused as a result of electrolyte imbalances and often complain of thirst. Older patients may not complain of thirst as a result of perceptual changes. Dehydration is evident by nonelastic skin turgor and delayed capillary filling.

DIF: Cognitive Level: Comprehension REF: p. 552 OBJ: 4 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Fluid and Electrolytes 3. Which treatment(s) would be considered safe for an infant? (Select all that apply.) a. Saline laxatives b. Bulk-forming laxatives c. Malt soup extract d. Stimulant laxatives ANS: B, C

Constipation in infants can be treated with a bulk-forming laxative and malt soup extract.

Saline laxatives are not appropriate for infants because of the risk of electrolyte imbalances.

Stimulant laxatives are not appropriate for infants.

DIF: Cognitive Level: Comprehension REF: p. 554 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Development

4. The nurse in a long-term care facility is preparing to pass medications to the residents. Which

residents should be administered an antidiarrheal? (Select all that apply.) a. An 80-year-old woman with diarrhea of sudden onset that has lasted 3 days b. A 76-year-old man with infectious diarrhea c. A 92-year-old man with diarrhea secondary to inflammatory bowel disease d. A 70-year-old woman with a history of chronic diarrhea from GI surgery e. An 88-year-old man that has had two episodes of stress-induced diarrhea ANS: A, C, D

Diarrhea of sudden onset lasting more than 2 or 3 days can cause significant fluid and water loss; therefore, an antidiarrheal is indicated. Patients with inflammatory bowel disease develop diarrhea. Rapid treatment shortens the course of the incapacitating diarrhea and allows the patient to live a more normal lifestyle. Postoperative GI surgery patients develop diarrhea. These patients may require chronic antidiarrheal therapy to allow adequate absorption of fluids and electrolytes. Antidiarrheals should not be given to patients known to have infectious diarrhea. Two bouts of diarrhea would not indicate a need for an antidiarrheal.

DIF: Cognitive Level: Analysis REF: p. 557 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Development

Chapter 35: Drugs Used to Treat Diabetes Mellitus Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which time will symptoms of hypoglycemia likely occur if a patient received the evening

dose of Lispro subcutaneously at 1630 PM? a. 1900 b. 1830 c. 0130 d. 0600 ANS: B

The most rapid-acting insulin, Lispro, peaks within 1 to 2 hours after administration. The peak time of insulin is when patients would most likely exhibit symptoms of hypoglycemia, particularly if they have inadequate dietary intake. The time of 19:00 would be past the peak of action and after signs of hypoglycemia would have appeared. The times of 01:30 and 06:00 are long after the peak of action and the time when signs of hypoglycemia would have appeared.

DIF: Cognitive Level: Application REF: p. 575 | p. 576 OBJ: 2 | 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Glucose Regulation | Safety 2. It is 2:00 PM and a patient who has been NPO since 12:00 AM for a bronchoscopy is

complaining of a headache and shakiness and is extremely irritable. Vital signs are within normal limits, and a one touch glucose reads 50 mg/dL. Which action is most important for the nurse to take? a. Have the patient eat a snack and drink milk. b. Administer glucagon subcutaneously.

c. Call the bronchoscopy room to follow up with the delay. d. Obtain an A1c test.

ANS: B

Irritability, nervousness, headache, tremors, dizziness, apprehension, sweating, cold and clammy skin, and hunger are symptoms of hypoglycemia. The patient has not eaten since the prior day. A blood glucose of 50 mg/dL is true hypoglycemia and needs to be dealt with immediately. Glucagon is preferred over PO intake, given that an endoscopy is scheduled.

Having the patient eat a snack and drink milk, calling the bronchoscopy room, and obtaining an A1c test are not appropriate responses.

DIF: Cognitive Level: Application REF: p. 572 OBJ: 2 | 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Diagnosis CON: Clinical Judgment | Glucose Regulation | Safety 3. After a blood glucose reading, it is determined that the patient should receive 4 units of Lispro

and 8 units of NPH. Which action will the nurse take to administer these medications? a. Draw up each insulin in separate syringes and administer two injections. b. Draw up the NPH first and then the Lispro using the same syringe. c. Administer the Lispro before the meal and the NPH after the meal. d. Draw up the Lispro first and then the NPH using the same syringe.

ANS: D

Lispro, an insulin analogue, is the most rapid-acting insulin. Insulin analogues are compatible with intermediate- (NPH) or long-acting insulin. When combining two types of insulin, the short-acting insulin is drawn up before the intermediate-acting insulin. There is no reason to administer a second injection. The long-acting insulin is drawn up last when mixing. Insulin is to be administered before meals.

DIF: Cognitive Level: Application REF: p. 578 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Glucose Regulation | Safety

OBJ: 1

4. A patient with type 2 diabetes mellitus, which was previously controlled with an oral

antidiabetic agent, is hospitalized for treatment of a leg ulcer. The healthcare provider has ordered sliding scale insulin coverage with regular insulin for hyperglycemia. The nurse brings the injection into the room, and the patient becomes upset, stating ―I don‘t want to start taking that drug! I‘ll need it the rest of my life.‖ Which response is best? a. ―This is the same drug as the oral medication you were taking. It‘s a stronger dose while you are in the hospital.‖ b. ―Don‘t worry. You shouldn‘t need this too often. As you feel better, your blood glucose level will drop.‖ c. ―Your body is under stress right now, which raises your blood glucose level. This does not mean you will be on this drug permanently. Once you‘re feeling better, your provider will determine if your oral medication is all you will need.‖ d. ―Your disease is progressing and your pancreas is producing less insulin. I know this is a hard time for you. Do you want to talk about it?‖ ANS: C

Type 2 diabetes mellitus patients normally controlled with oral hypoglycemics may require insulin during situations of increased physiologic and psychological stress. The stress response stimulates epinephrine and norepinephrine, which raises the blood glucose level.

Examples of stressors include pregnancy, surgery, and infections.

DIF: Cognitive Level: Application REF: p. 571 OBJ: 3 | 5 NAT: NCLEX Client Needs Category: Psychological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Glucose Regulation | Patient Education | Communication 5. Which test determines glycemic control over the previous 8 to 10 weeks? a. 24-hour glucose clearance test (GTT) b. Fructosamine test c. Fasting blood sugar (FBS) d. A1c test ANS: D

The A1c test measures the percentage of hemoglobin that has been irreversibly glycosylated because of high blood sugar levels. This test reflects the average blood sugar level attained over the past 8 to 10 weeks. The GTT is never conducted over an interval this long. The fructosamine test measures the amount of glucose bonded to a protein, fructosamine. This reflects the average blood glucose level attained over the past 1 to 3 weeks. The FBS measures the amount of glucose in the blood before eating.

DIF: Cognitive Level: Comprehension REF: p. 573 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Glucose Regulation | Safety 6. Which time is best for the nurse to administer Lispro? a. After the patient has started eating b. Within 10 to 15 minutes of eating c. 30 minutes before a meal d. 45 to 60 minutes before a meal ANS: B

Insulin analogues, such as Lispro and Aspart, are the most rapid-acting insulins. The onset of these insulins is within 10 minutes of the injection, they peak within 1 to 2 hours, and their duration is 3 to 5 hours. Patients should be eating their meal within 10 to 15 minutes of the injection.

DIF: Cognitive Level: Application REF: p. 578 OBJ: 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Glucose Regulation | Safety 7. Which intervention is most important for the successful management of diabetes mellitus? a. A network of community resources b. The level of self-management c. Preventative education d. Frequent follow-up with the healthcare provider ANS: B

Teaching patients to self-manage all aspects of their disease, including treatment modalities and preventing complications, is critical to patient success. Patients must be proficient in the entire therapeutic regimen—diet, activity level, blood or urine testing, medication, self-injection techniques, prevention of complications, and effective management of hypoglycemia or hyperglycemia. No outside source can overcome the failure of the patient to participate. Teaching the patient to prevent complications of his or her disease is important, but patient participation in managing the disease is crucial. No healthcare provider can overcome the failure of the patient to participate.

DIF: Cognitive Level: Comprehension REF: p. 574 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Glucose Regulation | Safety | Health Promotion | Patient Education 8. Which laboratory test is the preferred screening test for diabetes in children and nonpregnant

adults? a. FPG b. ECG c. GTT d. A1c ANS: A

The fasting plasma glucose (FPG) is the preferred test used to screen for diabetes in children and nonpregnant adults. Electrocardiograms (ECGs) are used to monitor electrical activity of the heart. The GTT is not recommended for routine clinical use but may be required in the evaluation of patients with impaired fasting glucose or when diabetes is still suspected, despite a normal FPG, as with the postpartum evaluation of women with gestational diabetes mellitus. The A1c test is used to monitor diabetes management over 90-day intervals, the life of a red blood cell.

DIF: Cognitive Level: Knowledge REF: p. 563 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Glucose Regulation | Safety | Development 9. Which response by the nurse is correct when a patient asks the nurse how sulfonylureas

normalize glucose levels? a. Stimulates pancreatic secretion of insulin b. Inhibits secretion of insulin by the pancreas c. Increases glucose production in the liver d. Increases insulin metabolism in the liver ANS: A

Sulfonylureas stimulate the pancreas to secrete more insulin. They also diminish glucose production and metabolism of insulin by the liver. The net effect is a normalization of insulin and glucose levels. Sulfonylureas decrease glucose production and hepatic metabolism of insulin.

DIF: Cognitive Level: Comprehension REF: p. 580 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 4

CON: Clinical Judgment | Glucose Regulation | Patient Education 10. Which statement by the patient indicates a need for further teaching about insulin

administration? a. ―I may need more insulin if I have surgery.‖ b. ―Once I open my insulin, I will store it in the refrigerator.‖ c. ―I will date the insulin bottle when I open it.‖ d. ―I will keep a spare bottle of insulin on hand.‖ ANS: B

Once insulin is opened and being used, it can be stored at room temperature for up to 1 month.

The patient may need more insulin if undergoing surgery, should date the insulin bottle after opening, and should keep a spare bottle of insulin on hand.

DIF: Cognitive Level: Comprehension REF: p. 577 OBJ: 1 | 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Glucose Regulation | Patient Education | Safety 11. Which instruction by the nurse is accurate to include when providing teaching to a patient

recently diagnosed with diabetes who has been prescribed insulin? a. Beta blockers can mask symptoms of hypoglycemia. b. Lipodystrophy increases the absorption of insulin. c. Infection will decrease the need for insulin. d. Excessive exercise will increase the need for insulin.

ANS: A

Beta-adrenergic blocking agents (e.g., propranolol, timolol, nadolol, pindolol) may mask many symptoms of hypoglycemia. Lipodystrophy does not increase the absorption of insulin.

Infection does not decrease the need for insulin. Excessive exercise does not increase the need for insulin.

DIF: Cognitive Level: Comprehension REF: p. 579 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Glucose Regulation | Patient Education | Safety 12. Which instruction is most important for the nurse to teach a patient with diabetes who is

receiving metformin? a. Take the medication before meals. b. This medication will cause the pancreas to secrete more insulin. c. Stop taking the drug 24 to 48 hours prior to radiopaque dye procedures. d. There may be an increase in the triglyceride level.

ANS: C

Radiopaque dyes often induce temporary renal insufficiency, so metformin should be discontinued 24 to 48 hours before procedures in which radiopaque dye will be administered.

Metformin is not administered before meals. The pancreas does not secrete more insulin as a result of taking this medication. Metformin does not increase triglyceride levels.

DIF: Cognitive Level: Comprehension REF: p. 580 NAT: NCLEX Client Needs Category: Physiological Integrity

OBJ: 4 | 5

TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Glucose Regulation | Patient Education | Safety 13. The nurse is caring for a patient with a new diagnosis of type 1 diabetes mellitus. Which goal

set by the patient will require revision? a. Patient will participate in 20 minutes of cardiovascular exercise 5 days a week. b. Patient will discontinue insulin use within 1 year. c. Patient will consume 20% of caloric intake from fat. d. Patient will demonstrate accurate self-glucose testing skills.

ANS: B

Type 1 diabetes mellitus requires the administration of insulin injections to replace the insulin that the body is no longer able to make. Participation in a regular exercise program is a realistic goal. A diabetic diet includes 20% to 35% of calories from fat. A person diagnosed with diabetes should be able to perform glucose testing.

DIF: Cognitive Level: Analysis REF: p. 569 OBJ: 3 | 5 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Planning CON: Clinical Judgment | Glucose Regulation | Safety 14. The nurse is administering sulfonylurea drugs to four different patients diagnosed with type 2

diabetes. Which patient should not receive the medication as ordered? a. A 42-year-old man with hypertension b. A 50-year-old woman with shingles c. An 80-year-old woman with an allergy to sulfa d. A 37-year-old man with a blood glucose level of 140 ANS: C

In general, sulfonylureas should not be administered to patients who are allergic to sulfonamides. These patients may also be allergic to sulfonylureas. There is no contraindication for administering sulfonylurea drugs to a 42-year-old man with hypertension, a 50-year-old woman with shingles, or a 37-year-old man with a blood glucose level of 140.

DIF: Cognitive Level: Analysis REF: p. 581 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity | NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment | Nursing Process Step: Implementation CON: Clinical Judgment | Glucose Regulation | Safety MULTIPLE RESPONSE 1. A third subclass of diabetes mellitus includes additional types of diabetes that are part of other

diseases having features not generally associated with the diabetic state. Which disorder(s) may have an associated diabetic component? (Select all that apply.) a. Patients receiving high-dose corticosteroid therapy for disease maintenance b. Cushing‘s syndrome c. Alzheimer‘s disease d. Acromegaly e. Malnutrition ANS: A, B, D, E

Drugs and chemicals that induce hyperglycemia are included in the third subclass of diabetes mellitus. Cushing‘s syndrome, acromegaly, and malnutrition are included in the third subclass of diabetes mellitus. Alzheimer‘s disease is not included in the third subclass of diabetes mellitus.

DIF: Cognitive Level: Comprehension REF: p. 563 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 2. A 65-year-old man is diagnosed with type 2 diabetes mellitus. Which patient symptom(s)

would indicate type 1 diabetes mellitus and not type 2? (Select all that apply.) a. Impotence b. Increased thirst over the past week c. A 10-lb weight loss within the past month d. Polyphagia e. Ketoacidosis ANS: B, C, D, E

Diabetes type 2 symptoms are insidious and patients present when symptoms may have been apparent for a prolonged time. Polydipsia, a 10-lb weight loss over this short period (1 month), polyphagia, and ketoacidosis are associated with type 1 diabetes. Onset of diabetes type 2 symptoms is usually in the fourth decade of life. Impotence is a symptom associated with type 2 diabetes mellitus.

DIF: Cognitive Level: Comprehension REF: p. 562 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 3. Which dietary control measures are used in the management of diabetes mellitus? (Select all

that apply.) a. Specific daily caloric requirements b. Consistent carbohydrate diabetes meal plan c. 50% intake of carbohydrates daily d. Adjustments to daily meals according to age, metabolic stress, pregnancy, and advanced age and/or older adults e. 20% intake of proteins daily ANS: B, C, D, E

Meal planning systems are used with the diabetic patient. The consistent carbohydrate diabetes meal plan is used, with an emphasis on consistency of timing of meals and snacks.

Daily meals and snacks provide 1500 to 2000 calories, with 50% of the calories from carbohydrates, 20% from protein, and 30% from fat. Individualized adjustments may be required with children, adolescents, metabolically stressed patients, pregnant women, and geriatric patients. Specific daily caloric requirement is not a primary consideration in calculating calorie requirements for a diabetic patient.

DIF: Cognitive Level: Comprehension REF: p. 569 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Glucose Regulation | Nutrition

OBJ: 1

4. Which statement(s) regarding type 2 diabetes mellitus would be correct? (Select all that

apply.) a. Type 2 diabetes is more prevalent in overweight people older than 45 years. b. A genetic predisposition exists for the development of type 2 diabetes mellitus. c. Type 2 diabetes requires lifelong insulin replacement. d. Type 2 diabetes is often diagnosed after complications have resulted. e. Women have a higher incidence of type 2 diabetes.

ANS: A, B, D, E

Contributing factors to the development of type 2 diabetes mellitus include being older than 45 years, being overweight, and having a family predisposition to the disease. The early symptoms of this type of diabetes are minimal; therefore, many patients do not seek medical assistance until the complications have appeared. Contributing factors to the development of type 2 diabetes mellitus include being female. In type 2 diabetes mellitus, the pancreas continues to secrete insulin. Patients may be diet controlled or regulated with oral hypoglycemics. Insulin is only used if the other treatments are not effective.

DIF: Cognitive Level: Comprehension REF: p. 562 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment 5. Which statement(s) regarding gestational diabetes would be true? (Select all that apply.) a. It is diagnosed in about 2% of all pregnancies in the United States. b. It includes diabetic women who become pregnant. c. Fetal development may be complicated as a result of gestational diabetes. d. The risk of developing diabetes after pregnancy is increased. e. Most women with gestational diabetes have normal glucose tolerance postpartum. f. Women need to be reevaluated postpartum to determine their classification with

respect to glucose tolerance.

ANS: C, D, E, F

Gestational diabetic individuals are put into a separate category because of the special clinical features of diabetes that develop during pregnancy and the complications associated with fetal involvement. These women are also at a greater risk of developing diabetes 5 to 10 years after pregnancy. The majority of individuals with gestational diabetes have normal glucose tolerance postpartum. Gestational diabetes patients must be reclassified 6 weeks after delivery into one of the following categories: diabetes mellitus, impaired fasting glucose, impaired glucose tolerance, or normoglycemia. Gestational diabetes is diagnosed in about 4% of all pregnancies in the United States. Gestational diabetes does not include diabetic women who become pregnant.

DIF: Cognitive Level: Comprehension REF: p. 563 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Glucose Regulation 6. Which information will be provided regarding the timing of testing when educating a patient

with diabetes mellitus regarding urine testing for ketones? (Select all that apply.) a. When illness occurs b. During pregnancy c. Before and after physical exercise d. When blood glucose is above usual range

e. Every morning upon awakening ANS: A, B, D

Ketone testing should be done when illness occurs, during pregnancy, and whenever blood glucose is elevated above the individual‘s usual range. It is not necessary to test urine for ketones before and after physical exercise or every morning upon awakening.

DIF: Cognitive Level: Application REF: p. 572 | p. 573 OBJ: 5 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Glucose Regulation | Patient Education | Safety

Chapter 36: Drugs Used to Treat Thyroid Disease Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which medication is used to treat hyperthyroidism? a. Levothyroxine (Synthroid) b. Liotrix (Thyrolar) c. Propylthiouracil (Propacil) d. Liothyronine (Cytomel) ANS: C

Propylthiouracil is an antithyroid agent used in the treatment of hyperthyroidism.

Levothyroxine, liotrix, and liothyronine are used to treat hypothyroidism.

DIF: Cognitive Level: Knowledge REF: p. 602 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Hormonal Regulation

OBJ: 2

2. A patient with a history of heart failure has been diagnosed with hypothyroidism. Which

change in therapy will most likely be required considering the interaction with glycosides and thyroid replacement therapy? a. Decrease in the daily digoxin dosage b. Gradual increase in the daily glycoside dosage c. Inability to begin thyroid replacement therapy because of the underlying heart condition d. Increased thyroid replacement dosage ANS: B

If thyroid replacement therapy is started while receiving digoxin, a gradual increase in the glycoside will also be necessary to maintain adequate therapeutic activity. Decreasing the digoxin would put the patient at risk for cardiovascular complications. The two treatments can be coordinated. The thyroid medication does not need to be increased.

DIF: Cognitive Level: Comprehension REF: p. 600-601 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 CON: Clinical Judgment | Safety

3. Which nursing problem may be identified for a patient with hyperthyroidism?

a. b. c. d.

Imbalanced nutrition: more than body requirements Constipation Disturbed sleep pattern Ineffective airway clearance

ANS: C

Hyperthyroidism is caused by an excess amount of thyroid hormones. Patients typically exhibit the following symptoms: rapid, bounding pulse (even during sleep); cardiac enlargement; palpitations; and dysrhythmias. Patients are nervous and easily agitated.

Reflexes are hyperactive and the patient typically experiences insomnia. A nursing diagnosis of ―disturbed sleep pattern‖ would be a common problem. The patient with hyperthyroidism is likely to consume less than body requirements and is not likely to be constipated as a result of the disease. Ineffective airway clearance is not a common problem of patients with hyperthyroidism.

DIF: Cognitive Level: Comprehension REF: p. 597 OBJ: 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Diagnosis CON: Clinical Judgment | Sleep | Hormonal Regulation 4. The nurse is providing instruction to a patient recently prescribed a radioactive iodine isotope.

Which action applies to this medication? a. Stimulates the synthesis of T3 and T4 hormones. b. Increases the storage of thyroxine before thyroid surgery. c. Destroys hyperactive thyroid tissue. d. Replaces deficient thyroid hormone.

ANS: C

The thyroid gland absorbs high concentrations of radioactive iodine, which destroys the hyperactive thyroid tissue with essentially no damage to other tissues in the body. Radioactive iodine does not stimulate hormone synthesis, increase hormone storage, or replace deficient hormones.

DIF: Cognitive Level: Comprehension REF: p. 601 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Communication | Patient Education | Hormonal Regulation 5. Which patient would be a candidate for radioactive iodine therapy? a. A 17-year-old woman with Graves‘ disease b. A 64-year-old woman with hypothyroidism c. A 46-year-old man with heart disease and thyroid cancer d. An 82-year-old man with myxedema crisis ANS: C

Patients typically treated with radioactive iodine therapy are those who are beyond childbearing years, those with severe complicating diseases (e.g., heart disease), those with recurrent hyperthyroidism after previous thyroid surgery, those who are poor surgical risks, and those who have unusually small thyroid glands. Women of childbearing age should not be treated with radioactive iodine. Hypothyroidism and myxedema are not treated with radioactive iodine.

DIF: Cognitive Level: Application

REF: p. 601

OBJ: 2

NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Evaluation CON: Clinical Judgment 6. Which medication is used in the treatment of hypothyroidism? a. Levothyroxine (Synthroid) b. Radioactive iodine c. Propylthiouracil (Propacil) d. Methimazole (Tapazole) ANS: A

Levothyroxine (T4) is one of the two primary hormones secreted by the thyroid gland. This hormone is partially metabolized to liothyronine (T3), so therapy with levothyroxine (Synthroid) replaces both hormones. Levothyroxine is considered the drug of choice for hormone replacement in hypothyroidism. Radioactive iodine, propylthiouracil, and methimazole are used to treat hyperthyroidism.

DIF: Cognitive Level: Knowledge REF: p. 600 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Hormonal Regulation 7. A patient with myxedema complains to the nurse that he has a ―hangover‖ the next morning

after taking a pain medication at night. Which explanation by the nurse is the most accurate? a. ―You have increased sensitivity to the medicine because of your thyroid condition.‖ b. ―Because you haven‘t been sleeping, you have increased fatigue and should increase the analgesic.‖ c. ―You are not taking enough thyroid medication and you should increase the dosage.‖ d. ―The pain medication is incompatible with your thyroid medication and you should find another analgesic to take.‖ ANS: A

Myxedema patients are sensitive to small doses of sedative hypnotics, anesthetics, and narcotics. Increasing the analgesic would only make the patient feel more lethargic in the morning. The patient should not change the dose of his thyroid medication without consulting his primary healthcare provider. Any pain medication is likely to have this effect because of the patient‘s thyroid condition.

DIF: Cognitive Level: Comprehension REF: p. 596 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Communication | Patient Education | Hormonal Regulation 8. Which condition can occur if congenital hypothyroidism is not treated? a. Diabetes b. Impaired vision c. Periorbital edema d. Cretinism ANS: D

Cretinism is a condition resulting from congenital hypothyroidism. Diabetes is not a complication of congenital hypothyroidism. Periorbital edema and impaired vision are complications of hyperthyroidism.

DIF: Cognitive Level: Knowledge REF: p. 597 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Hormonal Regulation 9. Which statement correctly identifies the mechanism of action of propylthiouracil? a. Blocks reuptake of thyroid hormone in the liver. b. Destroys hormone in the thyroid gland. c. Increases synthesis of hormone in the thyroid gland. d. Blocks synthesis of hormone in the thyroid gland.

ANS: D

Propylthiouracil and methimazole are antithyroid agents that act by blocking the synthesis of T3 and T4 in the thyroid gland. They do not destroy any T3 or T4 already produced, so there is usually a latent period of a few days to 3 weeks before symptoms improve once therapy is started. Antithyroid medications do not block reuptake of hormones, destroy hormones, or increase synthesis of hormone.

DIF: Cognitive Level: Comprehension REF: p. 602 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Hormonal Regulation

OBJ: 2

10. Which action will be implemented when assisting with the care of a patient with

hyperthyroidism? a. Provide a cool environment. b. Anticipate ordering a low-calorie diet. c. Limit daily caffeine intake. d. Encourage intake of bran products.

ANS: A

For the hyperthyroid individual, the nurse should plan to provide a cool, quiet, structured environment because the patient lacks the ability to respond to change and anxiety-producing situations and has intolerance to heat. The individual with hyperthyroidism is usually ordered on a high-calorie diet of 4000 to 5000 calories/day with balanced nutrients. The individual with hyperthyroidism is to have no caffeine products. Because of the risk for diarrhea, bran products should not be encouraged.

DIF: Cognitive Level: Application REF: p. 598 OBJ: 2 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Hormonal Regulation 11. The nurse transcribes a new order for liothyronine for a patient diagnosed with

hypothyroidism. Which information will be included when educating the patient about this medication? a. The onset of action is slower than that of levothyroxine. b. It is safe for patients with cardiovascular disease to take.

c. Adverse effects may occur up to 3 weeks after changes in therapy have been

initiated. d. Symptoms of adverse effects include tachycardia and weight gain.

ANS: C

Adverse effects may occur 1 to 3 weeks after changes in therapy have been initiated. Onset of action is more rapid than that of levothyroxine. It is not recommended for patients with cardiovascular disease. Symptoms of adverse effects include bradycardia and weight loss.

DIF: Cognitive Level: Comprehension REF: p. 600 OBJ: 1 | 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Communication | Patient Education 12. Medications ordered on a patient with hypothyroidism include liotrix and cholestyramine. The

nurse administers the dose of liotrix at 0800. Which time is best for the nurse to administer the cholestyramine? a. 0700 b. 0800 c. 1000 d. 1200 ANS: D

To prevent binding of thyroid hormones by cholestyramine, administer doses at least 4 hours apart.

DIF: Cognitive Level: Analysis REF: p. 601 OBJ: 1 | 3 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment | Nursing Process Step: Implementation CON: Clinical Judgment | Safety MULTIPLE RESPONSE 1. A patient recently completed radiation treatment for throat cancer and presents to the

healthcare provider‘s office with symptoms indicating possible hypothyroidism. Which symptom(s) would most likely be exhibited and/or reported? (Select all that apply.) a. Inability to sleep b. Weight gain c. Lethargy d. Nervousness e. Cold intolerance ANS: B, C, E

Symptoms associated with hypothyroidism include weight gain, lethargy, and cold intolerance. Inability to sleep and nervousness are not symptoms associated with hypothyroidism.

DIF: Cognitive Level: Comprehension REF: p. 596 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Hormonal Regulation

2. Which characteristic applies to antithyroid drugs that act on the thyroid gland? (Select all that

apply.) a. They are a physiologic hormone replacement. b. They block synthesis of T3 and T4 in the thyroid gland. c. They destroy T3 and T4. d. Immediate improvement is observed. e. They may be used before subtotal thyroidectomy.

ANS: B, E

Antithyroid drugs act by blocking the synthesis of T3 and T4. They are prescribed long term for patients with hyperthyroidism and may be used for short-term treatment before subtotal thyroidectomy. Antithyroid drugs are not related to synthetic or physiologic hormone replacement. Antithyroid drugs act by blocking the synthesis of, not destroying, T3 and T4.

There is a latency period of a few days to 3 weeks before symptoms improve.

DIF: Cognitive Level: Comprehension REF: p. 600 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Hormonal Regulation

OBJ: 3

3. Which information will the nurse include in discharge teaching provided to a postoperative

total thyroidectomy patient is started on levothyroxine (Synthroid) daily? (Select all that apply.) a. ―Close follow-up with your healthcare provider is important.‖ b. ―Notify your healthcare provider if you experience any palpitations or tachycardia.‖ c. ―A variation in emotions and personality is normal during this adjustment period.‖ d. ―Synthroid may be stopped as soon as the thyroid gland resumes functioning.‖ e. ―When energy levels have returned, Synthroid will be gradually tapered.‖ ANS: A, B, C

Early intervention in correcting complications from the surgery or the hormone replacement therapy is crucial for a timely and positive outcome. Adverse effects such as tachycardia, anxiety, weight loss, abdominal cramping, and diarrhea are common but should be reported to the healthcare provider. After surgery, the goal is to return the patient to a euthyroid state with the use of replacement therapy. During this time of adjustment, patients will experience symptoms related to fluctuations in hormonal levels. Variation in emotions and personality may occur. The total thyroidectomy patient no longer has a thyroid gland and will not have hormone secretion. Synthroid is indicated for lifelong use in the patient who has had a total thyroidectomy.

DIF: Cognitive Level: Comprehension REF: p. 600 | p. 601 OBJ: 1 | 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Communication | Patient Education | Hormonal Regulation 4. Which clinical manifestation(s) would the nurse assess in a patient with hypothyroidism?

(Select all that apply.) a. Cold intolerance, weight gain b. Nervousness, agitation c. Increased susceptibility to infection

d. Exophthalmos, fatigue e. Hypoactive reflexes ANS: A, C, E

Hypothyroid patients have a lower basal metabolic rate. This may be characterized by intolerance to cold, subnormal body temperature, weight gain, and slowness in motion, speech, and mental processes. Patients with hypothyroidism may become susceptible to infection. Nervousness and agitation are not manifestations of hypothyroidism. Exophthalmos and fatigue are not manifestations of hypothyroidism.

DIF: Cognitive Level: Comprehension REF: p. 596 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Hormonal Regulation 5. Which clinical symptom(s) would the nurse observe in a patient with thyrotoxicosis? (Select

all that apply.) a. Decreased metabolic rate b. Decreased heart rate c. Decreased body temperature d. Muscle tremors e. Restlessness f. Anxiety g. Sweating ANS: D, E, F, G

Thyrotoxicosis symptoms include muscle weakness and tremors, restlessness and nervousness, anxiety, sweating, increased metabolic rate, increased pulse rate (to perhaps 140 beats/min), and increased body temperature and a sensation of feeling too warm.

DIF: Cognitive Level: Comprehension REF: p. 597 OBJ: 2 | 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Hormonal Regulation

Chapter 37: Corticosteroids Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. A patient has been on high-dose corticosteroid therapy for the treatment of lupus

erythematosus. Which laboratory studies will the nurse monitor in addition to monitoring electrolyte levels? a. Complete blood count b. Partial thromboplastin time c. Liver function panel d. Blood glucose levels ANS: D

Corticosteroid therapy may induce hyperglycemia, particularly in prediabetic or diabetic patients. All patients must be monitored for the development of hyperglycemia, particularly during the early weeks of therapy. Steroids do not affect blood count, bleeding time, or liver function.

DIF: Cognitive Level: Application REF: p. 609 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Hormonal Regulation | Glucose Regulation 2. A patient who has been taking glucocorticoids over the past 3 months for Crohn‘s disease

comes in for a follow-up visit. On assessment, the nurse notes facial edema, thinning extremities, and a fatty deposition (buffalo hump) on the scapular area. The patient reports the symptoms of the Crohn‘s disease are ―somewhat better.‖ Which treatment will the nurse expect? a. Decrease the steroid dosage by one-half. b. Increase the steroid dosage. c. Maintain the steroid dosage. d. Immediately stop the steroid dosage.

ANS: C

Glucocorticoids are primarily used as anti-inflammatory agents. Because the symptoms are improving, the physician will most likely maintain the steroid dosage. Adverse effects are anticipated with corticosteroid therapy. Decreasing the dose will not help the condition.

Increasing the dose will exacerbate the adverse effects, and the condition is improving with the current dosage. Stopping the dosage will not help the condition or the adverse effects.

DIF: Cognitive Level: Application REF: p. 610 OBJ: 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Hormonal Regulation | Safety 3. Which rationale applies to administering glucocorticoid therapy as an adjunct to

chemotherapeutic agents? a. Assists with pain control. b. Raises blood sugar to meet the increased metabolic needs. c. Produces immunosuppression effects. d. Reduces mucositis.

ANS: C

Glucocorticoids have an anti-inflammatory and antiallergenic action. Suppression of inflammation resulting from cancer enhances the effectiveness of the chemotherapeutic agents. Glucocorticoids do not have an analgesic effect. Glucocorticoids increase blood glucose, but it is an adverse effect, not a primary effect. Glucocorticoids do not reduce mucositis.

DIF: Cognitive Level: Comprehension REF: p. 610 OBJ: 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Hormonal Regulation | Safety 4. Which treatment plan is appropriate for a patient with type 1 diabetes that is prescribed a

glucocorticoid for chronic obstructive pulmonary disease? a. A decrease in the amount of insulin needed b. No change in the amount of insulin needed c. An increase in the need for carbohydrates d. An increase in the insulin needed

ANS: D

Glucocorticoids may elevate blood glucose levels and induce hyperglycemia, particularly in prediabetic or diabetic patients. Insulin needs increase with an increase in blood glucose levels. Carbohydrate needs will not increase.

DIF: Cognitive Level: Application REF: p. 612 OBJ: 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Planning CON: Clinical Judgment | Hormonal Regulation | Glucose Regulation | Safety 5. Which condition would require mineralocorticoid replacement? a. Addison‘s disease b. Diabetes insipidus c. Myxedema d. Glomerulonephritis ANS: A

Addison‘s disease is a result of failure of the adrenal cortex to produce mineralocorticoids, glucocorticoids, and sex hormones. Replacement therapy of all hormones is essential for the patient to lead a healthy life. Diabetes insipidus is treated with vasopressin. Myxedema is treated with thyroid hormone. Glomerulonephritis is treated with antibiotics.

DIF: Cognitive Level: Comprehension REF: p. 610 OBJ: 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Hormonal Regulation 6. Which fluid replacement method will the nurse identify for a patient on a fluid restriction? a. Freely throughout the day and evening shift b. One-third of the allowed volume on each shift c. Half the volume with meals and the remainder divided among shifts d. As the patient desires ANS: C

When fluid restrictions are prescribed, one-half of fluid volume is generally given with meals.

The other half is given on a per shift basis. When allowed the opportunity to take fluids freely, most patients will use all of their allotment early in the day and not have enough left for meals and medications later. Because most patients are asleep on the night shift, the fluid requirement is less.

DIF: Cognitive Level: Comprehension REF: p. 608 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Fluid and Electrolytes | Safety

OBJ: 3

7. Which information will the nurse include in the teaching plan for a patient asking about the

use of salt substitutes while on a sodium-restricted diet? a. Salt substitutes may be high in potassium and should be used sparingly. b. Salt substitutes are safe for unlimited use. c. The salty flavor is reduced, so additional amounts are needed for desired flavor. d. Salt substitutes may interact with the patient‘s medications.

ANS: A

Potassium restrictions may be indicated if the patient is taking a potassium-sparing diuretic.

Salt substitutes may be high in potassium; therefore, their use must be limited. Salt substitutes tend to have a more salty taste than sodium chloride, so reduced amounts are needed to provide desired flavor. It is unlikely that salt substitute will interact with patients‘ medications.

DIF: Cognitive Level: Comprehension REF: p. 608 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Nutrition | Patient Education

OBJ: 3

8. Which type of psychiatric complication may be develop when a patient is on a high dosage of

corticosteroids over a period of time? a. Lethargy b. Psychotic behaviors c. Manic phases d. Anxiety attacks ANS: B

A patient receiving a higher dosage of corticosteroids is susceptible to psychotic behavioral changes. The most susceptible patient is one with previous histories of mental dysfunction.

Perform a baseline assessment of the patient‘s ability to respond rationally to the environment and the diagnosis of the underlying disease. Lethargy, mania, and anxiety are not common complications of treatment with corticosteroids.

DIF: Cognitive Level: Comprehension REF: p. 612 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Hormonal Regulation | Psychosis | Safety 9. Which rationale explains the need for monitoring vital signs of patients receiving

corticosteroids? a. Orthostatic hypotension b. Malignant hyperthermia c. Infection d. Hyperglycemia ANS: C

Patients receiving corticosteroids are more susceptible to infection, and fever is often an early indicator of infection. Glucocorticoids, however, sometimes suppress a febrile response to infection. Orthostatic hypotension is not a common adverse effect of treatment with corticosteroids. Malignant hyperthermia is an anesthetic-related complication. Hyperglycemia is a common adverse effect of treatment with corticosteroids, but it is not assessed by vital signs.

DIF: Cognitive Level: Comprehension REF: p. 606 | p. 607 | p. 612 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Infection | Safety 10. Which condition would most likely be present when assessing a patient for adverse effects of

long-term glucocorticoid therapy?

a. b. c. d.

Dehydration Hypotension Osteoporosis Thrombocytopenia

ANS: C

Long-term glucocorticoid therapy may produce osteoporosis. Dehydration, hypotension, and thrombocytopenia are not adverse effects of long-term glucocorticoid therapy.

DIF: Cognitive Level: Comprehension REF: p. 612 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 11. The nurse transcribes a new order for a patient for a fludrocortisone (Florinef). Which time

schedule will be given when planning the time of administration? a. With breakfast and dinner b. Once daily in the evening c. Before meals d. With lunch ANS: B

Mineralocorticoids are usually given once daily in the evening. Glucocorticoids are usually ordered twice daily with breakfast and with dinner.

DIF: Cognitive Level: Application REF: p. 610 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Hormonal Regulation | Safety 12. Which statement(s) made by a patient on a corticosteroid medication show(s) a need for

further education? a. ―I should increase my potassium intake.‖ b. ―I may have to decrease my fluid intake.‖ c. ―I will avoid weight-bearing measures.‖ d. ―I will change position frequently.‖ ANS: C

Weight-bearing measures should be encouraged for the patient taking corticosteroids to prevent calcium loss. An increase in potassium is often necessary when on corticosteroids.

Fluid restrictions may be imposed when taking corticosteroids. Position should be changed at least every 2 hours for the patient taking corticosteroids.

DIF: Cognitive Level: Comprehension REF: p. 609 OBJ: 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Patient Education | Safety | Communication MULTIPLE RESPONSE 1. Which information would be important to include when instructing a patient about adverse

effects associated with corticosteroid therapy? (Select all that apply.) a. Avoid crowds or people with an infection.

b. Monitor and care for your skin daily; change positions frequently. c. Take medication on an empty stomach. d. During periods of physical or psychological stress, higher doses of corticosteroids

are necessary. Contact your healthcare provider. e. Follow a diet low in sodium.

ANS: A, B, D, E

Corticosteroid therapy patients should avoid large crowds or people with an infection.

Patients taking corticosteroid drugs should monitor for signs of edema, skin breakdown, and weight daily. During periods of physical or psychological stress, increased dosing may be necessary. Patients taking corticosteroid drugs should follow a low-sodium diet that is also high in potassium, if not contraindicated. Corticosteroids should be taken with food to avoid gastrointestinal upset.

DIF: Cognitive Level: Comprehension REF: p. 608 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety | Health Promotion | Communication 2. Which function(s) applies to glucocorticoids? (Select all that apply.) a. Maintain fluid and electrolyte balance. b. Have anti-inflammatory activities. c. Regulate protein, carbohydrate, and fat metabolism. d. Provide relief of rheumatoid arthritis. e. Include aldosterone.

ANS: B, C, D

Glucocorticoids have anti-inflammatory and antiallergenic activities. Glucocorticoids (cortisone, hydrocortisone, prednisone, and others) regulate carbohydrate, protein, and fat metabolism. Glucocorticoids are effective for immunosuppression in the treatment of certain cancers, organ transplantation, autoimmune diseases (e.g., lupus erythematosus, dermatomyositis, rheumatoid arthritis), relief of allergic manifestations (e.g., serum sickness, severe hay fever, status asthmaticus), and treatment of shock. In addition, they may be used to treat nausea and vomiting resulting from chemotherapy. Glucocorticoids do not maintain fluid and electrolyte imbalance. Glucocorticoids do not include aldosterone.

DIF: Cognitive Level: Comprehension REF: p. 610 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Hormonal Regulation

OBJ: 1

3. A patient has been diagnosed with rheumatoid arthritis and will begin daily oral corticosteroid

treatment. Which baseline assessment(s) would be important for a patient receiving corticosteroids? (Select all that apply.) a. Baseline weight b. Blood pressure c. Complete blood cell count (CBC) d. Electrolyte studies e. Hydration status ANS: A, B, D, E

Baseline assessments for patients receiving corticosteroid therapy include weight, blood pressure, electrolyte studies, intake and output, and diet and hydration status. A baseline CBC is not needed for patients taking corticosteroids.

DIF: Cognitive Level: Comprehension REF: p. 606 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Hormonal Regulation | Fluid and Electrolytes | Safety 4. Which measure(s) for monitoring hydration and fluid balance would be inappropriate for the

patient on steroid therapy? (Select all that apply.) a. Daily weights b. Abdominal girth measurements c. Reports of thirst d. Neurologic assessment e. Assessment for alteration in skin integrity ANS: A, B

Perform daily weights using the same scale, in clothing of approximately the same weight, at the same time, usually before breakfast. Record and report significant weight changes.

(Weight gains and losses are the best indicators of fluid gain or loss.) As appropriate to the patient‘s condition, obtain and record abdominal girth measurements. Thirst, altered mental status, and alteration of skin integrity are late signs of dehydration and therefore not a good way to monitor fluid balance.

DIF: Cognitive Level: Application REF: p. 606 | p. 607 | p. 608 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Hormonal Regulation | Fluid and Electrolytes | Safety 5. Which primary therapeutic outcome(s) is expected from fludrocortisone (Florinef) therapy?

(Select all that apply.) a. Reduced inflammation b. Pain relief c. Blood pressure control d. Restored fluid and electrolyte balance ANS: C, D

Fludrocortisone is used in combination with glucocorticoids to treat salt-losing adrenogenital syndrome for blood pressure control and to restore fluid and electrolyte balance. Because fludrocortisone has mineralocorticoid and glucocorticoid effects, it has an antiinflammatory action. However, this is not one of the primary therapeutic outcomes expected from fludrocortisone therapy. Fludrocortisone does not relieve pain.

DIF: Cognitive Level: Comprehension REF: p. 610 OBJ: 1 | 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Hormonal Regulation | Fluid and Electrolytes | Perfusion 6. Which information will the nurse include in discharge teaching for a patient with type 2

diabetes is being discharged on glucocorticoid (prednisone) therapy for rheumatoid arthritis?

(Select all that apply.)

a. b. c. d. e.

―Daily, single-dose therapy should be taken in the morning.‖ ―The metabolic needs of your body will be increased.‖ ―Steroids should never be discontinued abruptly.‖ ―Signs and symptoms of infections may not be evident.‖ ―Blood glucose levels will be elevated on corticosteroid therapy.‖

ANS: A, C, D, E

During steroid replacement therapy, the drugs should mimic the body‘s circadian rhythm.

Steroids ordered once a day are given early in the morning. Steroid replacement therapy is gradually tapered in small increments before discontinuation to ensure that the patient‘s adrenal glands are able to start secreting steroids to compensate for the reduced drug dosage.

Glucocorticoids have an antiinflammatory action and therefore suppress the signs and symptoms of an infection. An adverse effect of glucocorticoid therapy is increased blood sugar levels. Glucocorticoids do not increase the body‘s metabolic needs.

DIF: Cognitive Level: Comprehension REF: p. 611 | p. 612 OBJ: 1 | 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Hormonal Regulation | Glucose Regulation | Safety 7. A patient has just received a new prescription for a corticosteroid medication. The nurse is

educating a patient on symptoms to report to the healthcare provider. Which information will the nurse inform the patient to report? (Select all that apply.) a. Productive cough b. Dyspnea c. Confusion d. Chest pain e. Weight gain ANS: A, B, C, D, E

Symptoms to be reported when on a corticosteroid include productive cough, dyspnea, confusion, chest pain, and weight gain.

DIF: Cognitive Level: Comprehension REF: p. 608 | p. 609 | p. 610 OBJ: 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Hormonal Regulation | Fluid and Electrolytes | Safety

Chapter 38: Gonadal Hormones Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. A female patient with a history of endometriosis presents with bilateral lower quadrant pain

reportedly at midcycle. Which gonadal drug is indicated for treating symptoms of endometriosis? a. Estrogen b. Progesterone c. Androgens d. Gonadotropins

ANS: B

Progesterones are used to treat secondary amenorrhea, breakthrough uterine bleeding, and endometriosis. They may be combined with estrogens as contraceptives. Estrogen products are used for relieving the hot flash symptoms of menopause; for contraception; for hormone replacement therapy after an oophorectomy; in conjunction with appropriate diet, calcium, and physical therapy in the treatment of osteoporosis; for treatment of severe acne in females; and to slow the disease progress (and minimize discomfort) in patients with advanced prostatic cancer and certain types of breast cancer. Androgens are used to treat hypogonadism, eunuchism, androgen deficiency, and palliation of breast cancer in postmenopausal women with certain cell types of cancer. When androgens are used for palliation of cancer in women, they suppress cancer cell growth. Gonadotropin is a hormone secreted in the pituitary; it regulates the release of the gonadal hormones.

DIF: Cognitive Level: Comprehension REF: p. 619 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Hormonal Regulation 2. Which rationale applies to the use of an androgen as part of breast cancer treatment? a. For maintenance of fat stores b. To promote nutrition c. To prevent wasting resulting from cancer growth d. For palliative treatment to suppress cancer cell growth ANS: D

When androgens are used for palliation of breast cancer in women, they suppress cancer cell growth. Androgens affect muscle growth, not fat stores. Estrogen affects fat stores. Although androgens may be used to stimulate appetite and improve nutrition, this is not the indication in this case. Although androgens may be used to prevent wasting, this is not the indication in this case.

DIF: Cognitive Level: Comprehension REF: p. 620 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Hormonal Regulation | Cellular Regulation 3. The health of a patient receiving androgen therapy for breast cancer declines and she becomes

bedbound. Which condition will this patient be at risk of developing? a. Electrolyte imbalances b. Hypercalcemia c. Hyperglycemia d. Fluid overload ANS: B

Immobilized patients receiving androgens for palliative breast cancer treatment are at risk for hypercalcemia. The nurse should monitor patients for nausea, vomiting, constipation, poor muscle tone, and lethargy. Immobilization does not affect electrolyte balance, blood glucose, or fluid balance in this case.

DIF: Cognitive Level: Comprehension REF: p. 622 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Hormonal Regulation

4. Which patient on oral contraceptive therapy will be at greatest risk for heart attack? a. A 34-year-old woman with a history of osteoporosis b. A 28-year-old woman with a history of eczema c. A 36-year-old woman who smokes half a pack per day d. A 36-year-old woman who has a history of abnormal Pap smears ANS: C

The incidence of fatal heart attacks is increased for women older than 35 years of age who use gonadal hormones and smoke. Osteoporosis, eczema, and cervical dysplasia do not increase risk for heart attack.

DIF: Cognitive Level: Comprehension REF: p. 616 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Hormonal Regulation | Safety 5. Which instruction is the most important for the nurse to remember when instructing the

patient about treatment with gonadal hormones? a. Dosage, schedule, and adverse effects b. Cost, storage, and route of administration c. Drug interactions and food interactions d. Scheduling follow-up appointments and lab studies ANS: A

Most gonadal hormones are prescribed to patients for prolonged self-administration.

Therefore, planning should stress patient education specific to the type of gonadal hormone prescribed and its intended actions, including monitoring of adverse effects to expect and report. Cost, storage, and route of administration are lesser concerns. There are few, if any, interactions between gonadal hormones and food or other drugs. Follow-up appointments and lab studies are lesser concerns.

DIF: Cognitive Level: Comprehension REF: p. 616 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Hormonal Regulation | Safety | Patient Education | Health Promotion 6. Which situation necessitates the need for immediate follow-up with the healthcare provider

for a young woman taking birth control pills? a. Breakthrough bleeding b. Nausea c. Missed dose d. Light menstrual flow ANS: A

Breakthrough bleeding is not an expected adverse effect and should be reported to a healthcare provider immediately to consider alternatives in therapy. Nausea is an expected adverse effect of contraceptive therapy. Missed doses are common and do not require notification of the provider. Light menstrual flow is common with contraceptive therapy.

DIF: Cognitive Level: Comprehension REF: p. 617 OBJ: 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation

CON: Clinical Judgment | Hormonal Regulation | Safety | Patient Education 7. Which statement is true regarding androgen therapy? a. Androgen use may cause hyperglycemia. b. Androgens should be administered with food or milk to avoid gastric irritation. c. Signs of masculinization will appear and are reversible. d. Electrolyte imbalances are extremely rare.

ANS: B

Androgens may cause gastric irritation and therefore can be given with food or milk.

Androgens cause hypoglycemia. Treatment is often stopped once signs of masculinization appear because these may not be reversible. Androgens cause electrolyte imbalances.

DIF: Cognitive Level: Comprehension REF: p. 621 OBJ: 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Hormonal Regulation | Safety 8. Which natural estrogenic hormones produced in the ovaries is the most potent? a. Estradiol b. Estrone c. Estriol d. Estrogen ANS: A

The natural estrogenic hormone released from the ovaries comprises several closely related chemical compounds: estradiol, estrone, and estriol. The most potent is estradiol.

Estradiol is metabolized to estrone, which is half as potent. Estrone is metabolized to estriol, which is considerably less potent. Estrogens are a group of steroid compounds named for their importance in the estrus cycle, functioning as the primary female sex hormone.

DIF: Cognitive Level: Knowledge REF: p. 616 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Hormonal Regulation 9. Which information will the nurse include when teaching a patient with seizures about estrogen

therapy? a. Phenytoin reduces the effectiveness of estrogen. b. Estrogen reduces the effectiveness of phenytoin. c. Phenytoin may inhibit the metabolism of estrogen. d. Estrogen may inhibit the metabolism of phenytoin.

ANS: D

Estrogens may inhibit the metabolism of phenytoin, resulting in phenytoin toxicity. Phenytoin does not reduce the effectiveness of estrogen. Estrogen does not reduce the effectiveness of phenytoin. Phenytoin does not inhibit the metabolism of estrogen.

DIF: Cognitive Level: Comprehension REF: p. 617 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Hormonal Regulation | Patient Education | Safety

10. Which potential side effect will be addressed when preparing a female patient for the

endocrine changes that may occur as a result of androgen changes? a. Priapism b. Voice changes c. Gynecomastia d. Fluid retention ANS: B

Women should be monitored for signs of masculinization, such as deepening of the voice.

Males should be carefully monitored for priapism and development of gynecomastia. Fluid retention is a metabolic effect, not an endocrine change, that may occur.

DIF: Cognitive Level: Comprehension REF: p. 622 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Hormonal Regulation | Patient Education MULTIPLE RESPONSE 1. Which use(s) apply(ies) to progestin therapy? (Select all that apply.) a. Contraception b. Endometriosis c. Amenorrhea d. Abnormal uterine bleeding e. Cancer ANS: A, B, C, D

Progestin therapy is used in combination with estrogens as a contraceptive, to relieve symptoms of endometriosis, for hormonal balance to relieve amenorrhea, and for hormonal balance to relieve abnormal uterine bleeding. Progestin is not used in cancer treatment.

DIF: Cognitive Level: Comprehension REF: p. 619 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Hormonal Regulation 2. The nurse is completing discharge teaching to a new mother who will begin oral

contraceptives. Which common adverse effect(s) should be expected? (Select all that apply.) a. Elevated blood pressure b. Breast tenderness c. Weight gain d. Edema e. Increased thirst ANS: B, C, D

Breast tenderness, weight gain, and edema are adverse effects to expect when beginning oral contraceptives. Elevated blood pressure and increased thirst are not adverse effects to expect from oral contraceptives.

DIF: Cognitive Level: Comprehension REF: p. 617 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 2

CON: Clinical Judgment | Hormonal Regulation | Safety | Patient Education 3. Which rationale(s) explains why estrogen therapy is used in postmenopausal women? (Select

all that apply.) a. Meets contraceptive needs b. Treats acne c. Prevents osteoporosis d. Treats hot flashes e. Maintains hormonal balance ANS: C, E

Estrogen therapy is used in conjunction with diet, calcium, and physical therapy in the prevention and treatment of osteoporosis and to slow the disease progression in patients with advanced prostate cancer and certain types of breast cancer. Postmenopausal females would take estrogen to maintain hormonal balance. Women of childbearing age use estrogen to meet contraceptive needs. Women who use estrogen to treat acne are not postmenopausal. Estrogen therapy is used to reduce the frequency of hot flashes of menopausal (not postmenopausal) women.

DIF: Cognitive Level: Comprehension REF: p. 617 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Hormonal Regulation | Health Promotion 4. Which condition(s) would be of special concern when evaluating a patient for treatment with

gonadal hormones? (Select all that apply.) a. Sexually transmitted disease b. Hypertension c. Liver disease d. Cancer of the reproductive organs e. Smoking ANS: B, C, D, E

Hypertension, liver disease, and cancer of the reproductive organs may be contraindications for treatment with gonadal hormones. Smoking increases the risk of heart attacks, stroke, and embolic disorders in patients taking gonadal hormones. Sexually transmitted diseases are not affected by treatment with gonadal hormones.

DIF: Cognitive Level: Comprehension REF: p. 617 OBJ: 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Hormonal Regulation | Safety 5. Which drug(s) will the nurse identify as causing drug interactions when teaching a patient

about estrogen therapy? (Select all that apply.) a. Diazepam (Valium) b. Warfarin (Coumadin) c. Thyroid hormones d. Phenytoin (Dilantin) e. Acetaminophen (Tylenol) ANS: B, C, D

Estrogen may diminish the anticoagulant effects of warfarin. Monitor the prothrombin time and increase the dosage of warfarin, if necessary. Patients who have no thyroid function and who start estrogen therapy may require an increase in thyroid hormone dosage. Estrogens increase thyroid-binding globulin levels, which reduce the level of circulating free T4. The total level of T4 is either normal or increased. Do not adjust the thyroid dosage until the patient shows clinical signs of hypothyroidism. Estrogens may inhibit the metabolism of phenytoin, resulting in phenytoin toxicity. Monitor patients with concurrent therapy for signs of phenytoin toxicity (e.g., nystagmus, sedation, lethargy). Serum levels may be ordered, and a reduced dosage of phenytoin may be required. There are no drug interactions with estrogen and diazepam or acetaminophen.

DIF: Cognitive Level: Comprehension REF: p. 617 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Hormonal Regulation | Safety | Communication | Patient Education 6. Which therapeutic outcome(s) is/are seen with the use of estrogen therapy? (Select all that

apply.) a. Contraception b. Hormonal balance c. Treatment of severe facial acne d. Appetite suppression e. Prevention of heart disease ANS: A, B, C

The primary therapeutic outcomes expected from estrogen therapy include contraception, hormonal balance, prevention of osteoporosis, palliative treatment of prostate and breast cancer, and treatment of severe acne in females. Appetite suppression and prevention of heart disease are not expected therapeutic outcomes of estrogen therapy.

DIF: Cognitive Level: Knowledge REF: p. 617 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Hormonal Regulation | Health Promotion | Patient Education 7. Which situation(s) would prompt the nurse to hold estrogen-containing medication to a

patient? (Select all that apply.) a. May be pregnant. b. Has a blood pressure of 130/70. c. Has a history of phlebitis. d. Reports breast tenderness. e. Is taking thyroid hormones.

ANS: A, C

The nurse must determine whether the patient is pregnant before starting estrogen therapy and the medication withheld if there is a possibility of pregnancy. Estrogen should be held and the healthcare provider contacted if the patient has a history of thromboembolitic disorders. A blood pressure of 130/70 is considered within normal limits. Breast tenderness is not a contraindication of estrogen administration. Thyroid hormones may need adjustment, but a patient taking estrogen can take thyroid hormones.

DIF: Cognitive Level: Comprehension REF: p. 617 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment | Nursing Process Step: Implementation | Nursing Process Step: Evaluation CON: Clinical Judgment | Hormonal Regulation | Safety

Chapter 39: Drugs Used in Obstetrics Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which drug will the healthcare provider prescribe to soften the cervix of a woman who is at

42 weeks of gestation? a. Methylergonovine (Methergine) b. Dinoprostone (Prepidil) c. Betamethasone (Celestone) d. Terbutaline (Brethine) ANS: B

Dinoprostone is a natural chemical in the body that causes uterine and gastrointestinal smooth muscle stimulation. It plays a role in cervical softening and dilation unrelated to uterine muscle stimulation. It is used to start and continue cervical ripening at term. Methergine is used to treat postpartum bleeding. Betamethasone is used to enhance fetal lung development.

Terbutaline is used to treat premature labor.

DIF: Cognitive Level: Comprehension REF: p. 631 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Reproduction

OBJ: N/A

2. Which reason indicates the reason that betamethasone IM will be administered to the mother

in premature labor? a. Stops uterine contractions b. Prevents precipitous labor c. Stimulates lung maturity in the fetus d. Stimulates prolactin to enhance breastfeeding ANS: C

Glucocorticoids may be administered IM to accelerate fetal lung maturation to minimize respiratory distress syndrome. Tocolytic drugs are given to stop uterine contractions. Prolactin production and release are triggered by pituitary hormone, estrogen, and progesterone.

DIF: Cognitive Level: Comprehension REF: p. 629 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Reproduction | Safety | Gas Exchange 3. A 26-year-old patient with preeclampsia is receiving IV magnesium sulfate. The 1400

assessment includes blood pressure, 100/70 mm Hg; respiration, 10; fetal heart tone, 100/min; urine output, 20 mL/hr; and absent patellar reflex. Which is the priority nursing action? a. Decrease IV magnesium sulfate to half the dose and reassess the patient and fetus in 15 minutes.

b. Stop the IV magnesium sulfate and contact the healthcare provider. c. Place the patient on her left side and administer oxygen. d. Stop the IV magnesium sulfate and administer calcium gluconate 5 mEq IV over 3

minutes.

ANS: D

The patient is exhibiting signs of magnesium sulfate toxicity, including respiratory depression.

The infusion should be stopped at once. The antidote, calcium gluconate, should be administered.

DIF: Cognitive Level: Application REF: p. 639 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Reproduction | Safety | Gas Exchange | Perfusion 4. Which drug is administered after delivery to reduce the risk of postpartum hemorrhage after

the placenta has been delivered? a. Oxytocin (Pitocin) b. Magnesium sulfate c. Vitamin K d. Dopamine ANS: A

Uterine stimulants, primarily oxytocin, given in low-dose infusions after delivery of the fetus and placenta, help stimulate firm uterine contractions to reduce the risk of postpartum hemorrhage from an atonic uterus. Magnesium sulfate is given to treat eclampsia and preeclampsia. Vitamin K is given to prevent hemorrhage. Dopamine is given to treat hypotension.

DIF: Cognitive Level: Comprehension REF: p. 636 OBJ: 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Reproduction | Safety 5. A 36-week primigravida patient has been admitted to the unit with a blood pressure of

200/120 mm Hg, severe headache, and edema. Which medication does the nurse anticipate that the healthcare provider will order? a. Nifedipine (Procardia) b. Furosemide (Lasix) c. Magnesium sulfate d. Terbutaline (Brethine) ANS: C

Magnesium sulfate depresses the central nervous system and blocks peripheral nerve transmission, which produces anticonvulsant effects and smooth muscle relaxation. In cases of preeclampsia or eclampsia, magnesium sulfate is used to control seizure activity.

Hypertension, headache, and edema are signs of preeclampsia in a pregnant woman. Calcium channel blockers, such as nifedipine, are sometimes given as tocolytic agents. Furosemide is given for diuresis; it may be used in the treatment of hypertension, but not eclampsia.

Terbutaline is given as a tocolytic agent.

DIF: Cognitive Level: Application

REF: p. 639

OBJ: 3

NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Reproduction | Perfusion | Safety 6. Which drug is administered when a patient is experiencing premature labor? a. Magnesium sulfate b. Oxytocin (Pitocin) c. Levonorgestrel (Mirena) d. Terbutaline (Brethine) ANS: D

Terbutaline is a beta-adrenergic receptor stimulant, which acts primarily on the beta-2 receptors. Stimulation of beta-1 receptors produces uterine relaxation and relaxation of the bronchial and vascular smooth muscle. In higher doses, terbutaline will stimulate the beta-1 receptors, which raises heart rate. Magnesium sulfate is given to treat eclampsia. Oxytocin is given to produce uterine contractions. Levonorgestrel is a progestin given for contraception.

DIF: Cognitive Level: Comprehension REF: p. 629 OBJ: 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Reproduction | Safety 7. A patient is a gravida 1, Rh-negative woman at a 28 weeks‘ gestation. The father of her child

is Rh positive. The mother is asking the nurse about the effect on her unborn child of RhoGAM that has been ordered. What is the nurse‘s best reply? a. ―Your child will do well after birth once transfusions are administered.‖ b. ―If the baby is Rh negative at birth, he or she will need RhoGAM also.‖ c. ―RhoGAM kills antibodies you make, so your child will be protected.‖ d. ―Your baby may be Rh positive and cause you to make antibodies. These won‘t affect this baby but could affect future children if RhoGAM isn‘t given.‖ ANS: D

An Rh-negative mother and an Rh-positive father have the potential for an Rh-positive baby.

At birth or during any time that the uterus ruptures, fetal blood circulation can mix with maternal circulation, causing the mother to produce antibodies (active immunity) against Rh-positive blood. This would cause Rh hemolytic disease in children of future pregnancies.

Rho(D) immune globulin suppresses the stimulation of active immunity by Rh-positive foreign red blood cells that enter maternal circulation at the time of delivery, at the termination of pregnancy, or during a transfusion of inadequately typed blood. Transfusions may cause further problems. Immune globulin is given to the mother. The drug does not kill antibodies; it suppresses production.

DIF: Cognitive Level: Application REF: p. 632 OBJ: 4 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Reproduction | Safety | Patient Education 8. Which drug will the nurse administer to prevent neonatal conjunctivitis in the newborn? a. Silver nitrate b. Dexamethasone c. Erythromycin

d. Vitamin K ANS: C

Erythromycin or tetracyclines are the drugs of choice because they prevent neonatal conjunctivitis from Neisseria gonorrhoeae and chlamydial ophthalmia neonatorum from Chlamydia trachomatis. Silver nitrate is an outdated treatment for neonatal ocular infections.

Dexamethasone is given for lung development. Vitamin K is given for treatment of hemorrhage.

DIF: Cognitive Level: Comprehension REF: p. 640 OBJ: 4 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Infection | Safety 9. Which emergency drug must be available when caring for a patient receiving magnesium

sulfate? a. Naloxone b. Calcium gluconate c. Dextrose d. Dopamine ANS: B

Calcium gluconate is the antidote for magnesium sulfate and should always be available when magnesium sulfate is administered. Naloxone is an antidote for opioid drugs. Dextrose is given to treat hypoglycemia. Dopamine is given to treat hypotension.

DIF: Cognitive Level: Knowledge REF: p. 640 OBJ: 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Reproduction | Safety 10. Which test would the nurse anticipate to be done to determine if preterm labor is present in a

patient whose symptoms are questionable? a. Sonogram b. Fetal fibronectin test c. Amniocentesis d. Doppler study ANS: B

A fetal fibronectin test may be ordered to assess the presence of preterm labor in patients whose presenting symptoms are questionable so that early intervention (e.g., tocolytic therapy, corticosteroids, transport to a tertiary center) can be initiated when indicated. Sonograms determine the presence and viability of a fetus. Amniocentesis determines genetic problems in a fetus. Doppler determines circulation in the vascular system of the mother or the baby.

DIF: Cognitive Level: Comprehension REF: p. 626 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Reproduction | Safety 11. Which condition is characterized by seizures? a. Pregnancy-induced hypertension b. Preeclampsia

c. Eclampsia d. Premature rupture of membranes ANS: C

Eclampsia (convulsions accompanying preeclampsia) is characterized by seizures.

Pregnancy-induced hypertension is characterized by sudden hypertension (an elevation of systolic pressure 30 mm Hg or more than prior readings, systolic blood pressure of 140 mm Hg or more, or diastolic pressure of 90 mm Hg or more). Preeclampsia is characterized by elevated blood pressure and proteinuria. Premature rupture of membranes is characterized by leakage of amniotic fluid from the vagina.

DIF: Cognitive Level: Comprehension REF: p. 630 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Reproduction 12. Which medication is used to treat a patient with atonic uterus? a. Estradiol b. Ergonovine c. Ergotamine d. Egophony ANS: B

Continued intravenous infusions of low-dose oxytocin or intramuscular injections of ergonovine or methylergonovine may be used to stimulate firm uterine contractions to reduce the risk of postpartum hemorrhage from an atonic uterus. Estradiol is an estrogen and is not used to treat atonic uterus. Ergotamine is used to treat migraine headaches. Egophony is a change in lung sounds characteristic of plural effusion.

DIF: Cognitive Level: Comprehension REF: p. 636 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Reproduction | Safety

OBJ: 3

13. A woman is 32 weeks pregnant and has been examined by the healthcare provider on June 1.

She is scheduling her next appointment. Which date is the most appropriate for the nurse to schedule the appointment? a. June 9. b. June 16. c. June 30. d. July 7.

ANS: B

The pregnant woman who does not experience complications is usually examined monthly for the first 6 months, every 2 weeks in the 7th and 8th months, and weekly during the last month.

DIF: Cognitive Level: Analysis REF: p. 625 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Planning | Nursing Process Step: Implementation CON: Clinical Judgment | Reproduction | Health Promotion

14. The nurse administers hydralazine IV to control the blood pressure of a woman diagnosed

with preeclampsia. Which time would be the next assessment of blood pressure if the nurse administered this medication at 0800? a. 0803. b. 0815. c. 0830. d. 1000.

ANS: A

The vasodilator hydralazine is usually administered to control blood pressure. If IV has been given, monitor the maternal and fetal heart rates and the mother‘s blood pressure every 2 to 3 minutes after the initial dose and every 10 to 15 minutes thereafter.

DIF: Cognitive Level: Analysis REF: p. 630 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment | Nursing Process Step: Implementation CON: Clinical Judgment | Reproduction | Safety 15. Which potential problem is the priority when caring for the neonate immediately following

delivery? a. Bleeding b. Alteration in body temperature c. Airway clearance issues d. Infection ANS: C

Ensuring that the airway remains open is the priority because if the airway does not remain patent, oxygenation will be impaired. Risk for bleeding, altered body temperature, and risk for infection are relevant but not priorities at this time.

DIF: Cognitive Level: Comprehension REF: p. 633 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Diagnosis CON: Clinical Judgment | Gas Exchange | Safety MULTIPLE RESPONSE 1. Which assessment(s) will the nurse complete during routine pregnancy visits? (Select all that

apply.) a. Blood pressure b. Hemoglobin c. Weight d. Fetal heart sounds e. Glucose tolerance test (GTT) ANS: A, C, D

Assessments during routine pregnancy visits include blood pressure, weight, and fetal heart sounds. Assessments during routine pregnancy visits do not include hemoglobin or GTT. DIF: Cognitive Level: Comprehension REF: p. 625 NAT: NCLEX Client Needs Category: Physiological Integrity

OBJ: 1

TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Reproduction | Health Promotion | Safety 2. A patient at 33 weeks‘ gestation is admitted to the obstetric unit in active labor with

symptoms associated with pregnancy-induced hypertension (PIH). Which action(s) will the nurse implement? (Select all that apply.) a. Vital signs hourly b. Administration of IV pitocin c. Administration of magnesium sulfate IV d. Fetal stress test e. Assessment of deep tendon reflexes ANS: A, C, D, E

Important nursing assessments and/or interventions include monitoring of vital signs and level of consciousness continuously, continuous fetal monitoring with stress tests and external or internal fetal monitoring, and deep tendon reflexes. IV magnesium sulfate is often prescribed for patients with PIH. Oxytocin increases uterine contractions and is contraindicated in preterm labor.

DIF: Cognitive Level: Application REF: p. 630 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Reproduction | Safety

OBJ: 2

3. Which information will the nurse include when teaching a postpartum patient about expected

adverse effects of Rho(D) immune globulin? (Select all that apply.) a. Nausea b. Constipation c. Fever d. Insomnia e. Aches f. Diarrhea g. Anorexia ANS: C, E

Fever as well as generalized aches and pains is a common adverse effect of treatment with this drug. Nausea, constipation, insomnia, diarrhea, and anorexia are not adverse effects of Rho(D) immune globulin.

DIF: Cognitive Level: Comprehension REF: p. 632 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Reproduction | Patient Education

OBJ: N/A

Chapter 40: Drugs Used in Men’s and Women’s Health Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which organism causes leukorrhea? a. Herpes simplex

b. Mycoplasma hominis c. Human papillomavirus (HPV) d. Candida albicans ANS: D

Candida albicans infections of the mouth, gastrointestinal tract, or vagina may develop as secondary infections during the use of broad spectrum antibiotics, such as penicillins, tetracyclines, and cephalosporins. Herpes simplex, M. hominis, and HPV do not cause leukorrhea.

DIF: Cognitive Level: Knowledge REF: p. 644 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Infection 2. A patient states that she has a difficult time remembering when to resume her triphasic

contraceptive pills following her menses. Which alternative plan will the nurse suggest that she discuss with her healthcare provider? a. Changing to the 28-day packet b. Using the inert pills every other month c. Changing her prescription to the mini pill d. Calling the healthcare provider whenever she forgets to get appropriate instruction ANS: A

Using the 28-day packet would allow her to continue with the same type of combination oral contraception. The 28-day packet would allow her to continue daily pills and eliminate the need to recall. Using the inert pills on alternate months will alter her menstrual schedule.

Changing to the mini pill might not meet her contraceptive needs. It is unnecessary and inappropriate to contact the provider for missed doses.

DIF: Cognitive Level: Application REF: p. 650 | p. 652 OBJ: N/A NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Health Promotion | Communication | Collaboration | Adherence Behavior 3. Which situation is more likely to be experienced by women taking the mini pill as an oral

contraceptive? a. Ovulation, dysmenorrhea, and breakthrough bleeding b. Excessive weight gain and breast tenderness c. Increased estrogen-related adverse effects d. Difficulty breastfeeding after pregnancy ANS: A

The mini pill is made up of progestin, which inhibits ovulation. This form of contraception is an alternative for women particularly susceptible to adverse effects caused by estrogen therapy. Between 30% and 40% of women continue to ovulate with this form of contraception, however, and there is a slightly higher incidence of uterine and tubal pregnancies. Dysmenorrhea, manifested by irregular or infrequent menses and spotting between cycles, is common in women taking the mini pill. The mini pill has a reduced chance for weight gain and breast tenderness, does not contain estrogen, and does not cause difficulty with breastfeeding.

DIF: Cognitive Level: Comprehension

REF: p. 651

OBJ: 1

NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Evaluation CON: Clinical Judgment 4. Which condition would contraindicate the use of oral contraceptives? a. Sexually transmitted diseases (STDs) b. Hypothyroidism c. Varicose veins d. Thromboembolic disease ANS: D

Women who have a history of thromboembolic disease must consult with a healthcare provider before obtaining a prescription for an oral contraceptive. Serious adverse effects include embolisms and thrombus formation, cardiac abnormalities, seizures, and severe depression. STDs, hypothyroidism, and varicose veins do not pose a problem with contraceptive therapy.

DIF: Cognitive Level: Comprehension REF: p. 651 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety 5. Which explanation by the nurse is most accurate when a patient diagnosed with benign

prostatic hypertrophy asks why tamsulosin (Flomax), an alpha-1 adrenergic blocking agent, has been prescribed? a. Inhibits the action of testosterone. b. Improves sexual function. c. Reduces the size of the prostate. d. Increases urinary flow.

ANS: D

Alpha-1 adrenergic blocking agents are used to relax the smooth muscle of the bladder and prostate. Tamsulosin specifically blocks alpha-1 receptors on the prostate gland and certain areas of the bladder neck, causing muscle relaxation and increased urine flow in men with enlarged prostate glands. Adrenergic blocking agents do not affect hormone production, directly affect sexual function, or affect prostate size.

DIF: Cognitive Level: Comprehension REF: p. 662 | p. 663 OBJ: 4 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Communication | Patient Education 6. Which type of drug is most effective in the treatment of erectile dysfunction (ED)? a. Phosphodiesterase inhibitors b. Antiandrogen agents c. Sympathomimetic agents d. Alpha-1 adrenergic blocking agents ANS: A

Sildenafil (Viagra), a phosphodiesterase inhibitor, increases cyclic guanosine monophosphate concentrations in the corpus cavernosum, which results in smooth muscle relaxation and greater blood flow into the corpus cavernosum, producing an erection. Antiandrogen agents, sympathomimetic agents, and alpha-1 adrenergic blocking agents are not effective in treating ED.

DIF: Cognitive Level: Comprehension REF: p. 665 OBJ: 5 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Evaluation CON: Clinical Judgment 7. The nurse is teaching a patient beginning therapy with dutasteride (Avodart). Which time

period is correct in explaining how long will it take before the patient can expect results? a. 24 hours b. 2 weeks c. 1 month d. 6 months ANS: D

Longer than 6 to 12 months of treatment may be necessary to assess whether a therapeutic response has been achieved.

DIF: Cognitive Level: Comprehension REF: p. 663 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 4 CON: Clinical Judgment

8. Which rationale explains why m caution must be used when taking a phosphodiesterase

inhibitor to enhance male sexual function? a. It can become habit forming. b. Life-threatening consequences can occur with cardiovascular disorders. c. It is an ineffective treatment. d. It is expensive and available only by special prescription.

ANS: B

The patient must consult with a healthcare provider before using a phosphodiesterase inhibitor. People with cardiovascular disorders are particularly susceptible to life-threatening consequences with its use. It is unlikely that a patient will develop physiologic dependence on the medication, although psychological dependence may occur. Phosphodiesterase inhibitors can be a very effective treatment for ED. Phosphodiesterase inhibitors are readily available online and are not expensive.

DIF: Cognitive Level: Comprehension REF: p. 666 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Perfusion | Safety | Patient Education 9. Which mechanism describes whereby estrogen functions as a contraceptive? a. Inhibiting luteinizing hormone (LH), blocking release of ovum from a follicle b. Thinning cervical mucus, which inhibits sperm migration c. Trapping the ovum in the endometrial wall, preventing its growth d. Blocking follicle-stimulating hormone (FSH), thereby preventing release of ovum ANS: D

Estrogens block pituitary release of FSH, preventing the ovaries from developing a follicle from which the ovum is released. Progestins inhibit pituitary release of LH, the hormone responsible for releasing an ovum from a follicle. Estrogens and progestins alter cervical mucus by making it thick and viscous, inhibiting sperm migration. Hormones also change the endometrial wall, impairing implantation of the fertilized ovum.

DIF: Cognitive Level: Comprehension REF: p. 655 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Reproduction

OBJ: N/A

10. The nurse is instructing a patient on use of a transdermal contraceptive. Which statement by

the patient identifies a need for further education? a. ―Apply the first patch during the first 24 hours of the menstrual period.‖ b. ―Use a backup contraceptive concurrently for the first 7 days of the first cycle.‖ c. ―Fold the used patch over on itself before discarding.‖ d. ―Trim the patch carefully prior to application.‖ ANS: D

Patches should not be cut. The first patch should be applied during the first 24 hours of the menstrual period. A backup contraceptive should be used concurrently for the first 7 days of the first cycle. When removing the patch, it should be folded over on itself and placed in a sturdy container.

DIF: Cognitive Level: Comprehension REF: p. 655 OBJ: 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety | Communication | Patient Education 11. Which instruction will be relayed when a woman using the NuvaRing vaginal ring informs the

nurse that the ring was accidentally expelled a day ago? a. Rinse the ring in cool water and reinsert as soon as possible. b. Rinse the ring in hot water and reinsert as soon as possible. c. Rinse the ring in lukewarm water, reinsert, and use a non-hormonal backup contraceptive. d. Insert a new ring.

ANS: C

If the ring is expelled for longer than 3 hours, the patient should be instructed to rinse it in cool or lukewarm water, reinsert, and use a non-hormonal backup contraceptive for the next 7 consecutive days of continuous ring use. It is not necessary to insert a new ring after a day.

DIF: Cognitive Level: Application REF: p. 656 OBJ: 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Communication | Patient Education MULTIPLE RESPONSE 1. Which information is important to include in patient education when providing instruction on

use of over-the-counter miconazole (Monistat) cream to treat her vaginal yeast infection?

(Select all that apply.) a. Wash the genital area thoroughly before inserting the vaginal cream. b. Wash the applicator before usage. c. Wear a minipad to catch remaining discharge following vaginal administration. d. Wash hands before and after administration.

e. The sexual partner may require treatment as well.

ANS: A, C, D, E

It is imperative that proper cleansing of the genital area be done regularly using soap and water; rinse and dry well. A minipad should be worn to catch remaining discharge. Hands should be washed before and after medication insertion and before and after toileting. Both partners in a sexual relationship require treatment. The male partner may require oral anti-infectives. The vaginal applicator should be thoroughly washed with soap and water after each use and then dried.

DIF: Cognitive Level: Application REF: p. 646 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Communication | Patient Education 2. A nurse working at the community health clinic receives a call from a teen patient who reports

that she has missed one of her birth control pills. Which response by the nurse is accurate?

(Select all that apply.) a. Take the missed pill now. b. Take the next pill at the regularly scheduled time. c. Come into the clinic for a pregnancy test. d. Start with the next month‘s pill packet at day 1. e. Take the missed pill and the next pill together at the next regularly scheduled time.

ANS: A, B

If a patient misses one pill, she should take the missed pill immediately. Even if a patient misses one pill, she should take the next pill for that day on time after taking the missed pill immediately. A pregnancy test is not necessary. Starting the next month‘s pill packet at day 1 is not the appropriate action to take. Taking both the missed pill and the next pill at the next scheduled time is not the appropriate action to take.

DIF: Cognitive Level: Comprehension REF: p. 652 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Communication | Patient Education 3. Which important assessment(s) should be included when completing a female reproductive

history on a 16 year old? (Select all that apply.) a. Breast self-examination (BSE) routine b. Age of menarche and pattern of menses c. Smoking and blood pressure history when seeking a prescription for oral contraceptive pills (OCPs) d. Sexual orientation and number of partners e. Number of pregnancies, live births, miscarriages, and abortions f. Nutritional intake of carbohydrates ANS: A, B, C, D, E

All women of reproductive age should perform regular BSEs. Onset and pattern of menses provide baseline assessments for future comparison. OCPs are contraindicated in women who smoke or have hypertension. Sexual orientation and number of partners provide a baseline assessment for future STD assessments. Gestational history provides baseline information for future pregnancies. Nutritional intake of carbohydrates is not included when obtaining a female reproductive history.

DIF: Cognitive Level: Comprehension REF: p. 644 | p. 645 OBJ: N/A NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Communication | Patient Education 4. What information will the nurse include when giving instructions to a young female at an

outpatient clinic regarding combination OCP therapy? (Select all that apply.) a. Medication should be taken at approximately the same time daily. b. A backup birth control method should be used for the first 6 months. c. Medication should be discontinued 1 year before attempting pregnancy. d. Headaches, dizziness, and chest or abdominal pain should be reported immediately. e. If a pill is missed, take it immediately and remain on schedule for the next dosage.

ANS: A, D, E

Medications should be taken at approximately the same time daily. Headaches, dizziness, and chest or abdominal pain should be reported immediately to the healthcare provider because these may be symptoms of a serious adverse effect. If one pill is missed, patients are directed to take it as soon as possible and continue with their normal schedule. If more than one pill is missed and a period is skipped, patients should return to their healthcare provider for a pregnancy test before restarting contraception. A backup contraceptive method is recommended at any point with OCP therapy. Because of a possibility of birth defects, the pill should be discontinued 3 months before attempting pregnancy.

DIF: Cognitive Level: Comprehension REF: p. 652 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Communication | Patient Education 5. Which common (and usually self-limiting) adverse effect(s) will the nurse teach to a patient

beginning therapy with alfuzosin, an alpha-1 adrenergic blocking agent? (Select all that apply.) a. Nausea b. Insomnia c. Dizziness d. Headache e. Lethargy f. Anorexia ANS: C, D, E

Dizziness, headache, and lethargy are adverse effects of treatment with alfuzosin. Nausea, insomnia, and anorexia are not adverse effects of treatment with alfuzosin.

DIF: Cognitive Level: Comprehension

REF: p. 662 | p. 663

OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Communication | Patient Education 6. Which information will the nurse at an outpatient clinic educating a group of young adults

provide regarding prevention of the spread of sexually transmitted infections? (Select all that apply.) a. The use of hormonal contraceptives b. The use of latex condoms when infection is present c. Abstinence d. Frequent use of nonoxynol 9 e. The importance of ―partner services‖ ANS: C, E

Abstinence will prevent sexually transmitted infections, and use of sexual abstinence during the communicable phase of any disease will prevent reinfection. All sexual partners need to understand the importance of ―partner services,‖ the documentation of all sexual partners for the purpose of providing evaluation and treatment. Hormonal contraceptives do not prevent sexually transmitted infections. When infections are present, abstain from sexual intercourse.

A recent study indicates that frequent use of nonoxynol 9 may actually increase the risk of HIV infection during vaginal intercourse because of irritation of vaginal tissues.

DIF: Cognitive Level: Comprehension REF: p. 647 OBJ: N/A NAT: NCLEX Client Needs Category: Health Promotion and Maintenance | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Communication | Patient Education | Infection

Chapter 41: Drugs Used to Treat Disorders of the Urinary System Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which action is accurate regarding urinary antimicrobial agents? a. Reduce pain associated with bladder spasms caused by the infection. b. Enhance output enough to flush out the infection from the urinary tract. c. Eliminate urinary retention. d. Have an antiseptic effect on the urine and the urinary tract.

ANS: D

Urinary antimicrobial agents have an antiseptic effect on the urine and the urinary tract.

Pyridium reduces pain associated with bladder spasms related to urinary tract infection (UTI).

Antimicrobial agents do not enhance output or eliminate urinary retention.

DIF: Cognitive Level: Comprehension REF: p. 673 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Infection 2. Which drug would assist in relieving symptoms for a patient that reports moderate bladder

pain and spasms secondary to a UTI? a. Tolterodine (Detrol) b. Nitrofurantoin (Furadantin)

c. Phenazopyridine hydrochloride (Pyridium) d. Oxybutynin chloride (Ditropan) ANS: C

Phenazopyridine relieves burning pain, urgency, and frequency associated with UTIs. Tolterodine is given for treatment of overactive bladder (OAB). Nitrofurantoin is given for treatment of UTIs but does not treat bladder pain or spasms. Oxybutynin is given for treatment of OAB. DIF: Cognitive Level: Comprehension REF: p. 679 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 CON: Clinical Judgment | Pain

3. A patient is admitted with complaints of dysuria, frequency, and lower back pain. The

urinalysis report is positive for red blood cells, and the blood work shows an elevated white blood cell count. Which medication will the nurse anticipate that the healthcare provider will order? a. Meperidine (Demerol) b. Bethanechol chloride (Urecholine) c. Ciprofloxacin (Cipro) d. Metronidazole (Flagyl) ANS: C

Dysuria, frequency, lower back pain, hematuria, and leukocytosis are indicators of a UTI. A variety of antimicrobial agents, including ciprofloxacin, are used to treat UTIs. Meperidine masks symptoms of pain that could lead to a more specific diagnosis and will not treat the underlying problem. Bethanechol is given for treatment of nonobstructive urinary retention.

Metronidazole is given for treatment of vaginal infections.

DIF: Cognitive Level: Application REF: p. 673 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Infection | Pain 4. Which time period describes how often fosfomycin (Monurol) is usually administered when

used in the treatment of UTIs? a. In a one-time dose b. Once per day c. Once per week d. Monthly ANS: A

Fosfomycin is the first antibiotic to be approved for administration in a single treatment dose for the treatment of UTIs. Fosfomycin is used to treat females with uncomplicated acute cystitis caused by susceptible strains of Escherichia coli and Enterococcus faecalis.

Fosfomycin is not used in the treatment of kidney infections.

DIF: Cognitive Level: Knowledge REF: p. 674 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Infection

5. After undergoing prostate surgery, a patient is discharged on the medication phenazopyridine

hydrochloride (Pyridium) to assist with urinary catheter discomfort. Which information will the nurse include in the discharge teaching? a. Urine will have a foul smell while taking this medication. b. Diarrhea and abdominal cramping are expected adverse effects. c. The sclera of the eye is yellow while on therapy. d. Urine will appear reddish orange.

ANS: D

Phenazopyridine hydrochloride is used to produce a local anesthetic effect on the mucosa of the ureters and bladder. Patients should be instructed that phenazopyridine causes urine to become reddish orange, which is not a cause for alarm. Other secretions may also be reddish orange and contact lenses may become stained. Phenazopyridine does not cause a foul odor in the urine. Diarrhea is not a common adverse effect of phenazopyridine. Icterus is a sign of hepatic damage and should be reported to the healthcare provider.

DIF: Cognitive Level: Application REF: p. 679 OBJ: 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education 6. Which action accurately pertains to tolterodine (Detrol)? a. Restores bladder tone and function. b. Decreases the urge to void. c. Prevents urinary retention. d. Acidifies urine.

ANS: B

Tolterodine is used to reduce the urgency and frequency of bladder contractions and delay the initial desire to void in patients with an OAB. Tolterodine does not restore bladder tone and function, prevent urinary retention, or acidify urine.

DIF: Cognitive Level: Comprehension REF: p. 676 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Elimination 7. Which condition will neostigmine be used to treat? a. OAB b. UTI c. Postoperative or postdelivery urinary retention d. Benign prostatic hypertrophy ANS: C

OBJ: 1 | 3

Neostigmine is an anticholinesterase agent that binds to cholinesterase, preventing the destruction of acetylcholine. The acetylcholine accumulates at cholinergic synapses, and its effects become prolonged and exaggerated. This produces a general cholinergic response manifested by miosis; increased tone of intestinal, skeletal, and bladder muscles; bradycardia; stimulation of secretions of the salivary and sweat glands; and constriction of the bronchi and ureters. An OAB is treated with anticholinergic agents. Anticholinergic agents with more selective action on the bladder are darifenacin, oxybutynin, solifenacin, tolterodine, and trospium. UTIs are treated with antiinfectives. Benign prostatic hyperplasia-related urinary problems are treated with anticholinergic medications.

DIF: Cognitive Level: Knowledge REF: p. 676 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Elimination 8. Which organism causes most UTIs? a. Proteus mirabilis b. Klebsiella pneumoniae c. E. coli d. Pseudomonas aeruginosa ANS: C

Gram-negative aerobic bacilli from the gastrointestinal (GI) tract cause most UTIs. Escherichia coli accounts for about 80% of non-institutionally acquired uncomplicated UTIs. Although common, P. mirabilis and K. pneumoniae are not responsible for most UTIs. Pseudomonas aeruginosa is not the most common cause of UTIs. DIF: Cognitive Level: Knowledge REF: p. 670 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Infection 9. Which term relates to what becomes discolored by phenazopyridine (Pyridium) in addition to

the urine? a. Feces b. Sclera c. Sputum d. Saliva ANS: B

The urinary analgesic phenazopyridine hydrochloride will commonly turn the urine reddish orange. It may also affect the skin or sclera, in which case the healthcare provider should be contacted. Phenazopyridine does not discolor feces, sputum, or saliva.

DIF: Cognitive Level: Knowledge REF: p. 679 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 10. Which statement by the patient indicates a need for further teaching about an anticholinergic

agent prescribed for urinary retention? a. ―I will chew gum to relieve dry mouth.‖ b. ―I will limit my fluid intake.‖ c. ―I will eat fresh fruits.‖

d. ―I will not drive if I develop blurred vision.‖ ANS: B

Adequate fluid intake will help prevent constipation, which is a common adverse effect of urinary retention. Dry mouth can be relieved by chewing gum. Fresh fruits will help prevent constipation. Caution patients not to drive until they have adjusted to blurred vision.

DIF: Cognitive Level: Comprehension REF: p. 676 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Elimination 11. The nurse is preparing to administer a single-dose packet of fosfomycin to a patient diagnosed

with a UTI. Which action will the nurse take when preparing this medication? a. Pour contents into a soufflé cup and administer by mouth. b. Mix with 3 mL of normal saline and inject subcutaneously. c. Pour contents into 90 mL of juice, stir, and administer by mouth. d. Mix contents with 120 mL of water and administer by mouth.

ANS: D

Fosfomycin is administered by pouring the entire contents of a single-dose packet into 90 to 120 mL of water. Fosfomycin is not injected. Hot water should not be used.

DIF: Cognitive Level: Application REF: p. 674 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Physiological Integrity | NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Infection | Safety | Elimination 12. Which potential condition may the patient have when the nurse obtaining urine for analysis on

the patient in the labor and birth unit, assesses the urine to appear frothy? a. Gestational diabetes b. Infection c. Preeclampsia (toxemia) d. Dehydration ANS: C

Foamy or frothy urine may indicate protein; proteinuria is associated with kidney disease, toxemia of pregnancy (also found in leukemia), lupus erythematosus, and cardiac disease.

Foamy or frothy urine does not indicate gestational diabetes, infection, or dehydration.

DIF: Cognitive Level: Comprehension REF: p. 672 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment | Nursing Process Step: Evaluation CON: Clinical Judgment | Perfusion | Safety MULTIPLE RESPONSE 1. A patient has been taking an antimicrobial agent prescribed to treat a UTI for 2 days. She

contacts the healthcare provider‘s office to report persistence of symptoms. Which assessment(s) would be important when evaluating the medication effectiveness? (Select all that apply.) a. Complete emptying of the bladder b. Amount of pain with urination as well as frequency

c. d. e. f.

Amount of daily fluid intake and output GI symptom complaints Bleeding with urination Persistence of nocturia

ANS: A, B, C, D, E

Focused assessment of UTI symptoms includes assessing for urinary retention, pain and/or burning with urination, intake and output, GI symptoms, and bleeding with urination.

Nocturia is common with OAB syndrome, not a UTI. DIF: Cognitive Level: Application REF: p. 674 | p. 675 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Infection | Safety 2. The nurse is assisting with postpartum care for a mother who has given birth to her fourth

child. She reports a moderate amount of urinary incontinence since the birth of the third child and is concerned that this problem will worsen. Which instruction(s) may facilitate management of incontinence? (Select all that apply.) a. Instruction of proper wiping techniques to prevent bacterial infection b. Education on bladder training and Kegel exercises c. Information on personal hygiene measures to prevent perianal breakdown d. Information of incontinence products and appliances e. Importance of establishing a regular toileting schedule f. Importance of increasing fluid intake ANS: A, B, C, D, E

Patient education for incontinence includes teaching about proper wiping technique to prevent infection, Kegel and bladder training exercises, personal hygiene measures to prevent perianal breakdown, incontinence products and appliances for personal use, and the importance of responding to the urge to void and maintaining a regular toilet schedule. Patient education for incontinence does not include increasing fluid intake.

DIF: Cognitive Level: Application REF: p. 673 OBJ: 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Elimination | Patient Education 3. Which urinalysis properties are indicative of an infection when reviewing the urinalysis

results of an older adult patient admitted with elevated temperature and incontinence? (Select all that apply.) a. Straw color b. Foul odor c. Trace glucose d. pH of 8.2 e. Specific gravity of 1.014 ANS: B, D

Urinalysis properties indicating infection include a foul odor and pH greater than 8.0. Urine the color of straw, clear yellow, or amber is a normal finding. A trace amount of glucose in the urine is a normal finding. The normal range of specific gravity is 1.003 to 1.029.

DIF: Cognitive Level: Comprehension REF: p. 672 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Infection 4. Which intervention(s) will help stimulate urination when a patient is experiencing

postoperative urinary retention? (Select all that apply.) a. Reinforcing Kegel exercises b. Administration of bethanechol chloride (Urecholine) c. Pouring warm water over the perineum d. Increasing IV fluids e. Urinary catheterization ANS: B, C

Administration of bethanechol chloride stimulates the parasympathetic nerve, causing contraction of the detrusor urinae muscle in the bladder, usually resulting in urination. Placing the patient in the proper position to void, pouring warm water over the perineum, and running water in the sink are techniques used to assist with voiding. Although Kegel exercises may help patients with incontinence, it will not help in postoperative urinary retention. Increasing IV fluids and catheterization will not help stimulate urination.

DIF: Cognitive Level: Application REF: p. 673 OBJ: 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Elimination 5. Which drugs do Fluoxetine, erythromycin, clarithromycin, ketoconazole, itraconazole,

miconazole, vinblastine, ritonavir, and nefazodone may inhibit the metabolism of? (Select all that apply.) a. Warfarin b. Tolterodine c. Phenytoin d. Darifenacin e. Heparin f. Solifenacin ANS: B, D, F

These agents inhibit the metabolism of tolterodine, darifenacin, and solifenacin. Warfarin, phenytoin, and heparin are not influenced by these drugs.

DIF: Cognitive Level: Comprehension REF: p. 677 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 2 CON: Clinical Judgment | Safety

6. Which symptom should the nurse report to the healthcare provider when caring for a patient

taking Pyridium for the diagnosis of UTI? (Select all that apply.) a. Orange-colored urine b. Yellow sclera c. Flushing of the skin d. Headache e. Increased pain and burning ANS: B, E

Yellow sclera and skin can indicate serious adverse effects of Pyridium. Pyridium should decrease pain and burning. Orange urine, flushing of the skin, and headache are expected adverse effects.

DIF: Cognitive Level: Comprehension REF: p. 679 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Care Coordination

Chapter 42: Drugs Used to Treat Glaucoma and Other Eye Disorders Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. The nurse is preparing a patient for an ophthalmic examination. Which action occurs when the

nurse instills eyedrops to produce mydriasis? a. Drying of tears in the eyes b. Extreme dilation of the pupil c. Opening of the canal of Schlemm d. Paralysis of the ciliary muscle ANS: B

Dilating the eye before eye examinations allows for better visualization of the interior of the globe. Anticholinergic drugs may produce drying of tears in the eye as an adverse effect of use. Obstruction of the canal of Schlemm results in glaucoma. Paralysis of the ciliary muscle is cycloplegia.

DIF: Cognitive Level: Comprehension REF: p. 682 | p. 686 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 2. Which type of medication would be used to dilate the pupils before an eye examination? a. Osmotics b. Adrenergic agent c. Beta-adrenergic agent d. Corticosteroid ANS: B

Adrenergic agents are sympathomimetic. They cause pupil dilation, increased outflow of aqueous humor, vasoconstriction, relaxation of ciliary muscle, and a decrease in the formation of aqueous humor. Adrenergic agents are used to lower intraocular pressure (IOP) in open-angle glaucoma, relieve congestion and hyperemia, and produce mydriasis for ocular examinations. Osmotics are given to reduce IOP. Beta adrenergics are given for the treatment of asthma. Corticosteroids are given for acute allergic reactions in the eye.

DIF: Cognitive Level: Comprehension REF: p. 689 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment 3. Which medication is used to produce miosis following a diagnostic procedure? a. Pilocarpine (Pilocar) b. Mannitol (Osmitrol)

c. Atropine (Isopto Atropine) d. Epinephrine (EpiPen) ANS: A

Pilocarpine is a direct acting cholinergic agent that is used to counter the effects of mydriatic and cycloplegic agents after surgery or eye ophthalmoscopic examinations. Cholinergic agents also reduce IOP in glaucoma patients by widening the filtration angle that permits outflow of aqueous humor. Mannitol is an osmotic diuretic given to decrease ocular pressure by drawing aqueous humor from the eye. Atropine is a mydriatic agent given to dilate the pupil.

Epinephrine may be used to treat certain types of glaucoma.

DIF: Cognitive Level: Comprehension REF: p. 693 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment 4. Which discharge instruction will the nurse include for a patient sent home from the clinic who

is taking an adrenergic ophthalmic solution for an acute inflammation? a. Headaches and eye pain are adverse effects to be reported to the healthcare provider immediately. b. Mouth dryness should be reported immediately. c. Avoid driving or operating machinery until blurring subsides. d. ―Halos‖ or yellow rings around objects will be seen while taking this medication.

ANS: C

Adrenergic agents cause the smooth muscle of the ciliary body and iris to relax, producing mydriasis. Blurred vision will temporarily occur until the patient can adjust to the increased light coming into the eyes. Activities such as driving or operating machinery should be avoided until vision stabilizes. Sunglasses help reduce the brightness. These are common, mild adverse effects and usually resolve with continued therapy. Mouth dryness is a common adverse effect. Halos are a sign of acute closed-angle glaucoma.

DIF: Cognitive Level: Comprehension REF: p. 689 OBJ: 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Sensory Perception | Patient Education 5. Which action applies to timolol maleate (Timoptic), a beta-adrenergic blocking agent? a. Draws aqueous humor from the eye into the circulatory network. b. Increases the production of aqueous humor. c. Increases the outflow of aqueous humor. d. Decreases the production of aqueous humor.

ANS: D

Timolol maleate is a beta-adrenergic blocking agent used to reduce increased intraocular pressure. The exact mechanism of action of these medications is unknown, but they are believed to reduce the production of aqueous humor. Timolol is believed to decrease the production of aqueous humor.

DIF: Cognitive Level: Comprehension REF: p. 690 OBJ: 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Evaluation CON: Clinical Judgment

6. Which mechanism of action applies to osmotic agents when used to decrease IOP? a. Promoting outflow of the aqueous humor into the tear ducts b. Increasing plasma osmolarity and drawing extracellular fluid into the blood c. Blocking production of aqueous humor d. Decreasing viscosity of the tears and allowing fluid to drain away from the eye ANS: B

Osmotic agents elevate the osmotic pressure of the plasma, causing fluid from the extravascular spaces to be drawn into the blood. The effect on the eye is reduction of volume of intraocular fluid, which produces a decrease in IOP. Osmotic agents do not promote flow of aqueous humor into tear ducts, block production of aqueous humor, or decrease viscosity of tears.

DIF: Cognitive Level: Comprehension REF: p. 685 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 3 CON: Clinical Judgment

7. Which potential serious adverse effect is associated with mannitol (Osmitrol)? a. Bradycardia b. Fluid overload c. Anaphylaxis d. Fever ANS: B

Mannitol, an osmotic agent, acts on blood volume by pulling fluid from the tissue spaces into the general circulation (blood). Patients should be assessed at regularly scheduled intervals for signs and symptoms of fluid overload, pulmonary edema, or heart failure. Osmotic agents are not likely to cause bradycardia, anaphylaxis, or fever.

DIF: Cognitive Level: Knowledge REF: p. 685 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Fluid and Electrolytes | Safety 8. Which position will the nurse encourage when caring for a patient immediately following a

right-sided trabeculectomy? a. Prone b. Right side-lying c. Left side-lying d. Trendelenburg ANS: C

Following right-sided trabeculectomy, the patient is usually positioned on the back or on the unoperated side. Prone position, right side-lying, and Trendelenburg positions are not recommended after a trabeculectomy.

DIF: Cognitive Level: Application REF: p. 686 OBJ: 2 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety 9. The nurse is assisting with applanation tonometry on a patient at the ophthalmologist‘s office.

The results indicate the patient‘s reading to be 15 mm Hg. Which interpretation of results regarding IOP does the nurse document?

a. b. c. d.

Decreased Normal Slightly increased Severely increased

ANS: B

Normal IOP using an applanation tonometer is 10 to 21 mm Hg. DIF: Cognitive Level: Analysis REF: p. 686 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment MULTIPLE RESPONSE 1. Which statement(s) about aqueous humor is/are true? (Select all that apply.) a. Bathes and feeds the lens, posterior surface of the cornea, and iris. b. Maintains the iris color. c. Drains out of the eye through drainage channels located near the junction of the

cornea and sclera. d. Manufactures fluid for tear production. e. Flows out of the canal of Schlemm into the venous system of the eye.

ANS: A, C, E

Aqueous humor bathes and feeds the lens, posterior surface of the cornea, and iris. After it is formed, the fluid flows forward between the lens and the iris into the anterior chamber.

Aqueous humor drains out of the eye through drainage channels located near the junction of the cornea and sclera. Aqueous humor drains into a meshwork leading into the canal of Schlemm and into the venous system of the eye. Eye color is not dependent on the aqueous humor. Tears are produced by the lacrimal glands in the upper and lower eyelids.

DIF: Cognitive Level: Comprehension REF: p. 684 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 2. A factory worker had a chemical inadvertently splashed into his right eye. An eyewash was

used at the work site. Which nursing assessment(s) would be important to include? (Select all that apply.) a. Visual acuity b. Presence of pain, blurred or halo vision, or lack of vision c. Type of chemical d. Presence of nystagmus e. Presence of contacts or use of eyeglasses ANS: A, B, C, E

Important nursing assessments would include visual acuity and baseline vital signs. These assessments would also include subjective data such as pain, clarity, and acuity of vision; observation of any physical abnormalities of the eye or lid; pupil characteristics; drainage or excessive tearing; edema or redness; and interventions completed before arrival. Important nursing assessments would include the type and cause of injury and whether contacts or eyeglasses are worn. Nystagmus is involuntary, rhythmic, repeated oscillations of one or both eyes. The cause is unknown. It would be unrelated to chemical eye injury.

DIF: Cognitive Level: Application REF: p. 685 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 3. Which information will the nurse include when instructing a patient on the correct method of

instilling eyedrops? (Select all that apply.) a. With an infection, prevent cross-contamination and use a separate source of medication and droppers for each eye. b. Wash hands before and after administration. c. Place the lid on the surface area as instructed to avoid contamination. d. Never touch the tip of the dropper or opening of the ointment container. e. Wipe eye from the outer to inner canthus.

ANS: A, B, C, D

Separate medication sources should be used when an eye infection is present to avoid cross-contamination. Washing of hands before and after instillation will prevent infection. The medication lid should not lie with the opening down on any surface. Any medications instilled into the eye should be sterile. The medication tip should not touch anything, including the eye, face, or fingers. Wipe the eye from the inner canthus outward.

DIF: Cognitive Level: Comprehension REF: p. 683 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Health Promotion | Patient Education 4. A patient recently diagnosed with glaucoma is to begin drug therapy with carbonic anhydrase

inhibitors. Which assessment(s) would prompt the nurse to contact the healthcare provider?

(Select all that apply.) a. Electrolyte levels b. Any signs of gastric symptoms before initiating drug therapy c. Allergy to sulfonamides d. Patient history of menopause e. Elevated IOP levels ANS: A, C

Baseline electrolyte studies, weight, hydration data, vital signs, and mental status should be obtained before beginning drug therapy. Carbonic anhydrase inhibitors should be held and the healthcare provider notified if the patient is pregnant or allergic to sulfonamides. If the patient is experiencing gastrointestinal symptoms, the medication should be administered with milk or food. Menopause is unrelated to the condition of glaucoma or its treatment. Elevated IOP levels are associated with glaucoma and are an expected condition. They do not need to be reported to the healthcare provider.

DIF: Cognitive Level: Application REF: p. 687 | p. 688 | p. 689 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety 5. Which purpose relates to the administering of a cycloplegic agent? (Select all that apply.) a. Facilitate examination of the eye. b. Facilitate surgery on the eye.

c. Cause pupillary dilation. d. Paralyze the ciliary muscle. e. Decrease the production of aqueous humor.

ANS: A, B, D

The eye is easier to examine in some cases if the ciliary muscle is paralyzed. Surgery on the eye is easier when the ciliary muscle is paralyzed. Cycloplegic agents are used to paralyze the ciliary muscle in preparation for examination or surgery. Drugs that cause pupillary dilation are called mydriatic agents. Cycloplegic agents do not decrease the production of aqueous humor.

DIF: Cognitive Level: Comprehension REF: p. 692 OBJ: 3 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment 6. Which important teaching points are necessary for the nurse to review with a patient recently

diagnosed with open-angle glaucoma? (Select all that apply.) a. The disease will cause damage to the optic disk if left untreated. b. Symptoms are sudden and painful when the disease begins. c. Loss of peripheral vision is a common trigger for diagnosis. d. Total blindness may result if the glaucoma is not treated. e. Glaucoma is not a serious disease and will cause only mild inconvenience to the patient. f. Treatment is only necessary when symptoms are bothersome.

ANS: A, C, D

IOP builds up and, if not treated, will damage the optic disk. Initially, the patient has no symptoms, but over the years, peripheral vision is gradually lost. If glaucoma is left untreated, total blindness may result. Patients with glaucoma are initially asymptomatic. Glaucoma is a serious disease that, if left untreated, may result in total blindness. If glaucoma is not treated, IOP builds up and will damage the optic disk.

DIF: Cognitive Level: Comprehension REF: p. 684 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety

OBJ: 2

7. Which information will the nurse include when teaching the patient and family about

postoperative care for a trabeculectomy? (Select all that apply.) a. Use aseptic technique for all dressing changes and medication administration. b. Place the patient on the operated side. c. Avoid heavy lifting. d. Redness in the eye, pain, and swelling are common occurrences after surgery. e. Avoid straining on defecation.

ANS: A, C, D, E

Teach the patient and family proper hygiene and eye care techniques to ensure that medications, dressings, and/or surgical wounds are not contaminated during necessary eye care. Explain and enforce activity and exercise restrictions. To prevent an increase in IOP, instruct the patient to avoid heavy lifting, straining on defecation, coughing, or bending and placing the head in a dependent position. Teach the patient and family about signs and symptoms of infections and when and how to report them to allow early recognition and treatment of possible infection. Straining increases IOP and should be avoided. The patient is positioned on the unoperated side or the back.

DIF: Cognitive Level: Comprehension REF: p. 686 | p. 687 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety | Infection 8. Which information about common adverse effects of cholinergic agents should be included

when educating a patient? (Select all that apply.) a. Conjunctival irritation b. Headache c. Salivation d. Hypotension e. Bradycardia ANS: A, B

Conjunctival irritation and headache are common adverse effects of cholinergic agents.

Salivation, hypotension, and bradycardia are systemic adverse effects of cholinergic agents and may indicate toxicity.

DIF: Cognitive Level: Comprehension REF: p. 693 OBJ: 2 | 3 NAT: NCLEX Client Needs Category: Physiological Integrity | NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety

Chapter 43: Drugs Used to Treat Cancer Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which statement is accurate when educating a patient with cancer about combination

chemotherapy? a. ―Combination chemotherapy is the administration of an antineoplastic drug that will be toxic during a specific phase of cellular growth.‖ b. ―Combination chemotherapy is the administration of an antineoplastic drug that is active throughout the cell cycle.‖ c. ―Combination chemotherapy is the administration of antineoplastic drugs that change the way the body responds to cancer or strengthens the immune system.‖ d. ―Combination chemotherapy is the administration of antineoplastic drugs, which results in cell death during different phases of the cell cycle.‖ ANS: D

Use of combination drug therapy is superior in therapeutic effect to the use of single agent chemotherapy.

DIF: Cognitive Level: Comprehension REF: p. 701 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: 1

2. Which phase of the cell‘s life cycle does vincristine sulphate (Oncovin) act in? a. S phase b. Mitotic phase c. Phase G1 d. Phase G0 ANS: B

Vinca alkaloids block the formation of the mitotic spindle during mitosis, thus inhibiting cell division. The S phase is the stage of active synthesis of two sets of DNA. Phase G1 is considered a presynthetic phase in which the cell prepares for DNA synthesis by manufacturing necessary enzymes. G0 is the largest variable in the cell cycle and, during this resting phase, the cell is not actively replicating.

DIF: Cognitive Level: Knowledge REF: p. 701 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 CON: Clinical Judgment

3. Which statement correctly explains the importance of correlating the dosage schedule with

cell cycle–specific drug therapy? a. Ongoing proliferation of neoplastic tissue b. The known cellular kinetics of the neoplasm c. The hormonal requirements of the patient d. The body‘s response in strengthening the immune system ANS: B

Cell cycle–specific agent scheduling should be correlated with the known cellular kinetics of the particular type of neoplasm being treated. This type of drug is schedule dependent and selectively toxic when the cell is in a specific phase of growth. The object of chemotherapy is to stop the proliferation of neoplastic tissue. Hormones are only used in specific types of cancer and are not related to cell cycle specificity. Immunomodulators are used to enhance the body‘s response in strengthening the immune system.

DIF: Cognitive Level: Comprehension REF: p. 701 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 CON: Clinical Judgment

4. When are cancer cells most sensitive to chemotherapy? a. Resting phases b. Rapid division c. Remission intervals d. Slow replication ANS: B

The cancer cells are the most sensitive to chemotherapy when the cells are dividing rapidly.

Cancer cells are not sensitive to chemotherapy during resting phases, remission intervals, or slow replication.

DIF: Cognitive Level: Knowledge REF: p. 701 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 CON: Clinical Judgment

5. Which rationale correctly states the advantage of combination therapy using cell

cycle–specific and cell cycle–nonspecific agents? a. Decreased expense and time needed for administration b. Decreased toxicity to patients and the nurses who administer the drug c. Increased cell death in various cycles and decreased toxicity d. Increased rate of treatment success ANS: D

Combination therapy is far superior to the use of single agent therapy. The use of a cell cycle–specific and cell cycle–nonspecific agents together facilitates cell death during different phases of the cell cycle. Combination therapy is not more economical or faster. Combination therapy is not less toxic because it exposes patients and nurses to additional medications. The use of combination drug therapy allows for cell death during different phases of the cell cycle, but the agents often have toxic effects on different organs at different time intervals after administration.

DIF: Cognitive Level: Comprehension REF: p. 701 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment 6. Which rationale explains why a patient with prostate cancer is prescribed an estrogen? a. To achieve hormonal balance b. To decrease the rate of production for malignant cells c. To soften prostatic tissue d. To suppress prostate gland function ANS: B

Estrogen therapy is used during the treatment of prostate cancer to decrease the rate of production of malignant cells. The use of female hormones decreases the amount of male hormones available for use by the cancer cells. Estrogen is not given for hormonal balance, does not soften prostatic tissue, and does not suppress prostate gland function.

DIF: Cognitive Level: Comprehension REF: p. 701 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment 7. Which assessment by the nurse would be a sign of neurotoxicity related to chemotherapy? a. Paresthesia b. Euphoria c. Nausea d. Hallucinations ANS: A

Signs and symptoms of neurotoxicity include numbness and tingling in extremities, confusion, changes in gait, and motor weakness. Euphoria, nausea, and hallucinations are not signs of neurotoxicity related to chemotherapy.

DIF: Cognitive Level: Knowledge REF: p. 707 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety 8. Which symptom is the patient who is receiving bleomycin (Blenoxane) therapy most likely to

exhibit? a. Increased respiratory rate and cough b. Weight gain and peripheral edema c. Numbness and tingling of hands and feet d. Lethargy and orthostatic hypotension ANS: A

Compromised respiratory function may occur in patients receiving bleomycin therapy.

Increased respiratory rate and cough can be signs that further problems are developing, such as heart failure. Bleomycin does not cause weight gain, peripheral edema, numbness and tingling of hands and feet, lethargy, or orthostatic hypotension.

DIF: Cognitive Level: Comprehension REF: p. 701 | p. 702 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 9. Which rationale describes the purpose of administering filgrastim (Neupogen) to a patient

who is post-bowel resection resulting from cancer? a. Decreases the gastrointestinal (GI) toxicity resulting from chemotherapeutic agents. b. Suppresses the immune response. c. Works as an antiemetic and stimulate his appetite. d. Increases the white blood cell (WBC) counts.

ANS: D

Filgrastim works to stimulate WBC production and decrease the incidence of infection.

Filgrastim is a colony stimulating factor, which stimulates WBC proliferation and maturation.

It is particularly helpful for patients prone to neutropenia resulting from cancer therapy.

Filgrastim does not affect GI toxicity, suppress immune response (it works to enhance it), or affect appetite or nausea.

DIF: Cognitive Level: Comprehension REF: p. 704 OBJ: 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment 10. Which outcome is intended with the use of the chemoprotective drug amifostine (Ethyol)? a. Decreased nausea and vomiting b. Increased effectiveness of the chemotherapy c. Maintenance of body weight d. Decreased renal toxicity ANS: D

Amifostine is used to reduce the cumulative renal toxicity associated with the repeated administration of cisplatin in patients with advanced ovarian cancer. Chemoprotective drugs do not decrease nausea and vomiting, enhance the effectiveness of chemotherapy treatment, or help prevent weight loss.

DIF: Cognitive Level: Comprehension REF: p. 704 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 3 CON: Clinical Judgment

11. Which rationale explains why bone marrow stimulants are used in the treatment of cancer? a. Increases uptake of the chemotherapy from the interior of the bones b. Strengthens bones weakened by pathologic processes c. Enhances the patient‘s immune system during treatment d. Protects the bone marrow from destructive actions from the cancer treatment ANS: C

Bone marrow stimulants trigger the recovery of bone marrow cells several days earlier than would be the natural course of recovery. The major benefit to this earlier recovery is that patients‘ immune systems are able to respond to and stop infections from being so pathologic, and patients can be released from the isolation room several days earlier. Bone marrow stimulants do not increase uptake of drugs, strengthen bones, or protect the bone marrow from destructive effects of chemotherapy or radiation.

DIF: Cognitive Level: Comprehension REF: p. 703 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 4 CON: Clinical Judgment

12. Which statement by the patient indicates a need for further teaching after being provided

education about chemotherapy? a. ―I will shave with an electric razor.‖ b. ―I will take aspirin for a headache.‖ c. ―I will wash my laundry separate from other family members.‖ d. ―I will flush the toilet twice after using.‖ ANS: B

Patients should not take any aspirin or aspirin-containing products. Shaving with an electric razor is preferable for a patient undergoing chemotherapy because of the decreased risk of bleeding. The clothing of the chemotherapy patient should be washed separately from other household linens. Because most chemotherapeutic agents are excreted in the urine and feces, it is best to flush the toilet two or three times.

DIF: Cognitive Level: Comprehension REF: p. 705 | p. 706 | p. 707 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Patient Education | Safety 13. The nurse is caring for a patient diagnosed with breast cancer. The patient reports that she has

been experiencing frequent watery stools following chemotherapy treatment. Which action will be encouraged when educating the patient regarding dietary guidelines to help relieve symptoms? a. Eliminate spicy foods. b. Eat low-protein foods. c. Implement a high-roughage diet. d. Eat high-fat foods.

ANS: A

Elimination of spicy foods should be encouraged for the patient experiencing diarrhea resulting from chemotherapy. High-protein foods, a diet low in roughage, and a diet with low-fat foods should be encouraged for the patient experiencing diarrhea resulting from chemotherapy.

DIF: Cognitive Level: Application REF: p. 707 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Nutrition

OBJ: 5

14. The nurse is preparing to administer medroxyprogesterone acetate as prescribed to a patient

diagnosed with endometrial carcinoma. Which supply will the nurse obtain when preparing to provide this medication? a. A plastic medication cup b. A medicine dropper c. A subcutaneous needle and syringe d. An intramuscular (IM) needle and syringe ANS: D

Medroxyprogesterone is ordered at 400 to 1000 mg IM per week.

DIF: Cognitive Level: Application REF: p. 701 | p. 702 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education MULTIPLE RESPONSE 1. Which agents are considered major chemotherapeutic agents? (Select all that apply.) a. Alkylating agents b. Antineoplastic antibiotics c. Hormones d. Antimetabolites e. Antinuclear antibodies f. Chelating agents ANS: A, B, C, D

Alkylating agents, antineoplastic antibiotics, hormones, and antimetabolites are considered major chemotherapeutic agents. Antinuclear antibodies are antibodies produced by the immune system that attack the body‘s own tissues instead of foreign toxins. They are frequently present in people with systemic lupus erythematosus and, less commonly, in other diseases. Chelating agents are used to detoxify a patient from heavy metal poisoning.

DIF: Cognitive Level: Knowledge REF: p. 701 | p. 702 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment 2. Which nursing consideration(s) would be taken into account prior to the administration of

cisplatin IV? (Select all that apply.) a. Review of laboratory data for presence of myelosuppression and hepatic and renal parameters

b. c. d. e.

Administration of IV hydration as prescribed Administration of epoetin alfa (Epogen) Administration of prechemotherapy mesna (Mesnex) Assessment for dermatologic conditions

ANS: A, B, D

Premedication nursing considerations regarding cisplatin, an alkylating agent, include checking laboratory reports for baseline data reflecting hepatic and renal function and baseline hematologic studies that reflect the degree of myelosuppression present before initiating chemotherapy, assessing patient hydration and the healthcare provider‘s orders for oral and IV hydration instructions before drug therapy, and administering prechemotherapy drugs including mesna, ondansetron, and antianxiety drugs. Epogen is given to treat anemia associated with chemotherapy; it is not given before administration of chemotherapy.

Dermatologic assessment is not necessary before administering cisplatin.

DIF: Cognitive Level: Comprehension REF: p. 701 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 5 CON: Clinical Judgment | Safety

3. Which sign(s) and symptom(s) assessed by the nurse would indicate thrombocytopenia?

(Select all that apply.) a. Pinpoint red rash b. Casts in urine c. Brown, fatty stools d. Increase in menstrual flow e. Coffee-ground emesis ANS: A, D, E

Pinpoint red rash, an increase in menstrual flow, and coffee-ground emesis indicate thrombocytopenia, which causes an increased tendency to bleed. Thrombocytopenia may cause hematuria and dark, tarry stools.

DIF: Cognitive Level: Comprehension REF: p. 708 OBJ: 5 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 4. Which treatment(s) may be used alone or in combination for the treatment of cancer? (Select

all that apply.) a. Surgery b. Radiation c. Chemotherapy d. Immunotherapy e. Phlebotomy ANS: A, B, C, D

Treatment of cancer often requires surgery, radiation, chemotherapy, and/or immunotherapy.

Phlebotomy does not treat cancer cells.

DIF: Cognitive Level: Comprehension REF: p. 699 | p. 700 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment

5. Which information regarding skin care will the nurse include when educating the patient on

chemotherapy? (Select all that apply.) a. Vigorously drying the skin with a bath towel b. Avoiding sunlight c. Using mild soap d. Avoiding moisturizer e. Bathing in lukewarm water ANS: B, C, E

The need to avoid sunlight should be stressed to avoid a photosensitive reaction. The patient should bathe in lukewarm water and use mild soap. Skin should be gently patted dry. Use of skin moisturizer should be discussed with the physician.

DIF: Cognitive Level: Comprehension REF: p. 707 OBJ: 5 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education | Safety

Chapter 44: Drugs Used to Treat the Musculoskeletal System Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. A patient who has undergone a lengthy surgical procedure under general anesthesia is unable

to breathe on his own following the procedure. Which drug will the nurse expect to be administered as an antidote to the neuromuscular-blocking agent? a. Dantrolene (Dantrium) b. Neostigmine methylsulfate (Prostigmin) c. Ether d. Baclofen (Lioresal) ANS: B

Neostigmine methylsulfate is an antidote to neuromuscular-blocking agents. Additional measures to implement include artificial respirations with oxygen and atropine sulfate for bradycardia and hypotension. Dantrolene is a direct-acting skeletal muscle relaxant given for the treatment of neuroleptic malignant syndrome associated with the use of antipsychotic agents. Ether is a general anesthetic. Baclofen is a skeletal muscle relaxant.

DIF: Cognitive Level: Comprehension REF: p. 717 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Gas Exchange

OBJ: 2

2. Which rationale explains why a paraplegic patient would receive baclofen (Lioresal)? a. Interruption of reflexes at the level of the spinal cord. b. Acts directly on the skeletal muscles to reduce spasticity. c. Interruption of the transmission of impulses from motor nerves to muscles at the

skeletal neuromuscular junction. d. Production of generalized mild weakness of skeletal muscles and decreases the

force of reflex muscle contractions.

ANS: A

Baclofen is a gamma-aminobutyric acid derivative that interrupts polysynaptic reflexes at the level of the spinal cord. Baclofen does not appear to act directly on the skeletal muscles.

Interrupting transmission of impulses from motor nerves to muscles at the skeletal neuromuscular junction is the mechanism of action of neuromuscular-blocking agents.

Producing generalized mild weakness of skeletal muscles and decreasing the force of reflex muscle contractions is the mechanism of action of dantrolene.

DIF: Cognitive Level: Comprehension REF: p. 716 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 CON: Clinical Judgment

3. A patient taking antipsychotic medication for schizophrenia is admitted with a temperature of

106F. The admitting diagnosis is neuroleptic malignant syndrome resulting from antipsychotic medication. Which drug is indicated in treatment of this condition? a. Edrophonium (Tensilon) b. Dantrolene (Dantrium) c. Baclofen (Lioresal) d. Metaxalone (Skelaxin) ANS: B

Dantrolene, a direct-acting skeletal muscle relaxant, is used to treat neuroleptic malignant syndrome associated with the use of antipsychotic agents. Edrophonium is an antidote for neuromuscular-blocking agents. Baclofen is a skeletal muscle relaxant used for the treatment of muscle spasticity resulting from multiple sclerosis (MS) and cerebral palsy. Metaxalone is used for muscle spasms.

DIF: Cognitive Level: Comprehension REF: p. 716 | p. 717 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety 4. Which is the priority problem when caring for a patient on a ventilator and receiving

succinylcholine (Anectine)? a. Pain b. Body image issues c. Injury risk d. Deficit in self-care ANS: A

Pain is the highest priority, according to Maslow‘s hierarchy of needs. Succinylcholine, a neuromuscular-blocking agent, is used to paralyze muscles while a patient is on a ventilator.

Neuromuscular-blocking agents do not relieve pain. Disturbed body image is not a priority for this situation, although it does apply. Risk for injury and self-care deficit are not as great of priorities for this situation.

DIF: Cognitive Level: Application REF: p. 717 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Diagnosis CON: Clinical Judgment | Pain 5. Which explanation by the nurse is most accurate when a patient‘s family asks why

neuromuscular-blocking agents are used before electroconvulsive therapy? a. ―They stimulate respirations while therapy is delivered.‖

b. ―They prevent aspiration of respiratory secretions during the therapy.‖ c. ―They decrease intracranial pressure resulting from therapy.‖ d. ―They reduce the risk of injury during therapy.‖ ANS: D

Neuromuscular-blocking agents are used before electroconvulsive therapy to paralyze the skeletal muscles and reduce the risk of fractures during therapy. Neuromuscular-blocking agents do not stimulate respiration, prevent aspiration, or affect intracranial pressure.

DIF: Cognitive Level: Comprehension REF: p. 717 OBJ: 2 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment 6. Which laboratory values will the nurse review prior to beginning medication therapy for

skeletal and muscle disorders? a. Sodium, magnesium, and chloride b. C-reactive protein (CRP), human leukocyte antigen (HLA), and liver function tests c. Arterial blood gases (ABGs), complete blood count (CBC), and electrolytes d. Glucose, high-density lipoproteins (HDL), and prothrombin time (PT) ANS: B

Examine laboratory reports associated with the disease process present (e.g., calcium, phosphorus, lupus testing, rheumatoid factor, uric acid level, CRP, HLA, aldolase, aspartate, creatine kinase). Electrolytes, trace minerals, ABGs, CBC, electrolytes, glucose, HDL, and PT are not associated with this disease process.

DIF: Cognitive Level: Application REF: p. 712 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 7. Which medication will be prescribed for a patient complaining of muscle spasms resulting

from a back injury? a. Acetaminophen (Tylenol) b. Morphine sulfate c. Bethanechol (Urecholine) d. Cyclobenzaprine (Flexeril) ANS: D

Cyclobenzaprine is a centrally acting skeletal muscle relaxant, which is a group of drugs used to relieve acute muscle spasms. Their exact mechanism of action is unknown, except that they depress central nervous system (CNS) function. All the centrally acting skeletal muscle relaxants produce some degree of relaxation, and healthcare providers maintain that the benefits from the sedative effects may exceed the benefits from actual muscle relaxation.

Acetaminophen, morphine, and bethanechol do not relieve skeletal muscle spasms.

DIF: Cognitive Level: Comprehension REF: p. 715 | p. 716 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Pain 8. Which symptoms will be most important for the nurse to assess for early signs of respiratory

distress in the patient who has been given a neuromuscular-blocking agent? a. Nasal flaring and retraction of intercostal muscles

b. Dyspnea, increased respiratory rate, and cyanosis c. Restlessness, anxiety, and lethargy d. Pallor, stridor, and diaphoresis ANS: C

The signs of restlessness, anxiety, lethargy, decreased mental alertness, and headache are early, subtle clues to respiratory distress. Retractions, flaring, dyspnea, hyperventilation, cyanosis, pallor, stridor, and diaphoresis are not early signs of respiratory distress.

DIF: Cognitive Level: Comprehension REF: p. 718 OBJ: 2 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Gas Exchange 9. Which common adverse effects occur with neuromuscular-blocking agents? a. Fever b. Flushing c. Nausea d. Ataxia ANS: B

Neuromuscular-blocking agents cause histamine release, which may cause bronchospasm, bronchial and salivary secretions, flushing, edema, and urticaria. Ensure that the airway is patent and that secretions are suctioned regularly to prevent obstruction. Report evidence of bronchospasm, edema, and urticaria immediately. Neuromuscular-blocking agents do not commonly cause fever, nausea, or ataxia.

DIF: Cognitive Level: Comprehension REF: p. 718 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 10. Which assessment is most important for the nurse to obtain when a patient is being treated

with a neuromuscular-blocking agent? a. Skin assessment for rash and urticaria b. Blood pressure assessment for orthostatic hypotension c. Respiratory assessment for patent airway d. Assessment for fluid volume overload ANS: C

Histamine release caused by these drugs may produce increased salivation. In patients who are paralyzed or who have incomplete return of control over swallowing, coughing, and deep breathing, these secretions may obstruct the airway. Histamines are not likely to produce rash or urticaria related to the administration of neuromuscular-blocking agents. Patients on neuromuscular-blocking agents are generally kept on bed rest and not subject to orthostatic hypotension. Neuromuscular-blocking agents do not cause fluid volume overload.

DIF: Cognitive Level: Comprehension REF: p. 718 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Gas Exchange 11. Which drug interaction may occur when an aminoglycoside or tetracycline is given in

conjunction with neuromuscular-blocking agents? a. Deep sedation

b. Decreased effectiveness of antibiotics c. Increased neuromuscular-blocking activity d. Sensitivity to antibiotics and possible allergic reaction ANS: C

Question antibiotic orders that prescribe aminoglycosides or tetracycline when neuromuscular blockers have been used. These drugs may potentiate the neuromuscular-blocking activity.

This combination of medications would not cause deep sedation. Neuromuscular-blocking agents do not decrease the effectiveness of antibiotics or increase sensitivity to antibiotics.

DIF: Cognitive Level: Comprehension REF: p. 718 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 2 CON: Clinical Judgment | Safety

12. A patient taking a neuromuscular-blocking agent is assessed to have a heart rate of 120 and

blood pressure of 80/50. Which diagnostic test with the nurse anticipate the physician writing an order for? a. ABGs b. Blood glucose level c. CBC d. Liver function tests ANS: A

Patients taking neuromuscular-blocking agents should be monitored closely for clinical signs of hypoxia and hypercapnia (tachycardia, hypotension, and cyanosis). ABG levels may be determined to confirm the clinical observations. Blood glucose levels, CBC, and liver function tests would not be indicated with these symptoms.

DIF: Cognitive Level: Application REF: p. 712 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment | Nursing Process Step: Implementation CON: Clinical Judgment | Gas Exchange 13. Which position is best to assist a conscious patient from the postoperative unit after

administration of a neuromuscular blocker into once vital signs are stable? a. Sims‘ b. Semi-Fowler‘s c. Supine d. Prone ANS: B

Patients can usually cough better in a semi-Fowler‘s or high Fowler‘s position; therefore, depending on the situation and stability of the patient‘s vital signs, elevating the head of the bed may assist coughing and breathing. Sims‘, supine, and prone are not the best positions for a patient postoperatively.

DIF: Cognitive Level: Application REF: p. 713 OBJ: 2 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety

MULTIPLE RESPONSE 1. Which conditions present in patients must be carefully assessed to determine whether they

would tolerate treatment with a neuromuscular-blocking agent? (Select all that apply.) a. Pregnancy b. Hepatic disease c. Pulmonary disease d. Renal disease e. Neurologic disorders f. Psychiatric disorders ANS: B, C, D, E

Patients with hepatic disease, pulmonary disease, renal disease, and neurologic disorders such as myasthenia gravis, spinal cord injury, or MS must be fully evaluated to assess their ability to tolerate neuromuscular-blocking agents. Neuromuscular-blocking agents can usually be used safely with the pregnant patient and the psychiatric patient.

DIF: Cognitive Level: Comprehension REF: p. 718 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 2. Which assessment data are needed to evaluate the patient in the emergency department whose

chief complaint is a dislocated shoulder? (Select all that apply.) a. Details related to the mechanism of injury b. Degree of impairment c. Pain level d. Inspection of the affected part for swelling, capillary refill, bruising, redness, localized tenderness, deformities, and paresthesia e. Elevation of the affected extremity ANS: A, B, C, D

Important nursing assessment of a musculoskeletal injury includes mechanism of injury, degree of impairment, pain level, and obvious deformity and neurovascular assessment.

Elevating the affected extremity would exacerbate the pain and deformity of the injury.

DIF: Cognitive Level: Application REF: p. 712 | p. 713 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Mobility | Pain | Safety 3. An employee at a factory has not been to work because of low back muscle spasms. His wife

contacts the occupational health nurse to report that her spouse is on a centrally acting skeletal muscle relaxant and is having problems with sleepiness. Which information will the nurse provide based on the medication action? (Select all that apply.) a. ―The healthcare provider should be notified because these drugs are contraindicated in the treatment of low back pain.‖ b. ―Your husband should avoid activities requiring alertness, such as driving or operating power equipment.‖ c. ―I need additional and specific information regarding the amount of your husband‘s sedation.‖ d. ―I will review baseline laboratory studies, discuss your husband‘s status with the healthcare provider, and call you back.‖

e. ―Sedation is an adverse effect of these medications and tends to resolve with

continued therapy.‖ ANS: B, C, D, E

Patients should be instructed to avoid activities that require alertness, such as driving or operating heavy machinery, for safety. When obtaining patient information regarding adverse effects, additional information may be needed to fully assess the degree of adverse effects the patient may be experiencing. Review of baseline liver and kidney function and CBC laboratory data is necessary. Centrally acting skeletal muscle relaxants are used to relieve acute muscle spasm. They act on the CNS, and sedation may be an adverse effect associated with usage. This tends to be mild and will resolve with continued use. These drugs are indicated for the treatment of low back pain.

DIF: Cognitive Level: Application REF: p. 714 | p. 715 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Patient Education | Communication 4. Which explanation(s) are correct in indicating why neuromuscular-blocking agents are used?

(Select all that apply.) a. Alleviation of pain b. Reducing the use and adverse effects of general anesthetics c. Easing endotracheal intubation and prevent laryngospasm d. Producing amnesia during painful procedures e. Decreasing muscular activity in electroshock therapy ANS: B, C, E

Neuromuscular-blocking agents are used to produce adequate muscle relaxation during anesthesia to reduce the use (and adverse effects) of general anesthesia, ease endotracheal intubation and prevent laryngospasm, and decrease muscular activity in electroshock therapy.

Neuromuscular-blocking agents have no effect on the pain threshold, memory, or consciousness.

DIF: Cognitive Level: Application REF: p. 717 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 4 CON: Clinical Judgment

5. When assessing a patient for signs and symptoms of early respiratory depression immediately

after leaving the postoperative area, the nurse will be alert for signs of what? (Select all that apply.) a. Restlessness b. Anxiety c. Lethargy d. Increased mental alertness e. Cyanosis ANS: A, B, C

Early signs of diminished ventilation include restlessness, anxiety, lethargy, decreased mental alertness, and headache. Increased mental alertness is not an early sign of respiratory depression. Cyanosis is a late sign of respiratory complications.

DIF: Cognitive Level: Comprehension

REF: p. 718

OBJ: 2

NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Gas Exchange | Safety

Chapter 45: Drugs Used to Treat Infections Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. A patient allergic to penicillin is being evaluated for a gram-negative infection. Which

antimicrobial drug class would the healthcare provider be cautious in prescribing because of a possible cross sensitivity and/or allergic reaction? a. Cephalosporins b. Aminoglycosides c. Sulfonamides d. Quinolones ANS: A

Cephalosporins may be used with caution as alternatives when patients are allergic to the penicillins, but cephalosporins are chemically similar in structure to penicillins and may produce a cross sensitivity and/or allergic reaction. Aminoglycosides, sulfonamides, and quinolones do not tend to produce cross sensitivities.

DIF: Cognitive Level: Comprehension REF: p. 732 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 3 CON: Clinical Judgment | Safety

2. The healthcare provider has prescribed penicillin and probenecid for a patient with a sexually

transmitted disease. Which rationale accurately describes the purpose of combining these medications? a. Accelerates the excretion of the penicillin b. Inhibits the absorption of penicillin to allow the drug to remain in the transport phase c. Inhibits the excretion of the penicillin d. Reduces toxic effects associated with penicillin ANS: C

The combination therapy of penicillin and probenecid allows the penicillin to remain in the body longer, which enhances drug availability and action. The combination may be used advantageously in treating serious or resistant infections. Probenecid inhibits the excretion of penicillin, slows down the excretion of penicillin, and does not affect absorption or toxic effects.

DIF: Cognitive Level: Comprehension REF: p. 742 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 1 CON: Clinical Judgment | Safety

3. Which symptom is most important for the nurse to monitor when an older adult who has

septicemia is receiving IV aminoglycoside therapy? a. Bone marrow suppression b. Ototoxicity c. Gastrointestinal (GI) distress

d. Photosensitivity ANS: B

Eighth cranial nerve damage can result from aminoglycoside therapy. Patients should be monitored during therapy and after therapy has been discontinued for signs and symptoms of ototoxicity, including dizziness, tinnitus, and progressive hearing loss. Aminoglycosides do not produce bone marrow depression; this is characteristic of treatment with chloramphenicol.

Aminoglycosides do not typically produce GI distress. Aminoglycosides do not produce photosensitivity; this is characteristic of treatment with glycylcyclines.

DIF: Cognitive Level: Application REF: p. 729 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Sensory Perception 4. On the basis of which factor an antimicrobial agent is selected? a. Sensitivity of the microorganism to the drug b. Half-life of the medication c. Therapeutic levels of the drug d. Bioavailability of the drug ANS: A

The selection of the antimicrobial agent must be based on the sensitivity of the pathogen and the possible toxicity to the patient. The half-life of the drug is not a concern with selection in comparison to sensitivity. Therapeutic levels of the drug are not criteria for selection.

Bioavailability is a lesser concern than sensitivity.

DIF: Cognitive Level: Comprehension REF: p. 724 OBJ: 1 | 4 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Evaluation CON: Clinical Judgment 5. A patient is scheduled to take tetracycline and aluminum hydroxide (Amphojel) at the same

time. Which time accurately describes when the nurse will administer the medications to achieve the optimal effects? a. Both medications together b. Amphojel 30 minutes before tetracycline c. Tetracycline with orange juice d. Tetracycline 1 hour before Amphojel ANS: D

For optimal effectiveness, tetracyclines should be administered 1 hour before or 2 hours after ingesting antacids, milk, or other dairy products or products containing calcium, aluminum, magnesium, or iron. Taking the drugs this closely together will most likely inhibit absorption of the antibiotic. Tetracycline does not tend to interact with orange juice, but the beverage may be contraindicated in a patient who needs to take antacids.

DIF: Cognitive Level: Application REF: p. 747 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment 6. Which conditions may occur with the administration of broad-spectrum antibiotics over an

extended period of time? a. Cross sensitivity

b. Immunosuppression c. Secondary infection d. Immunity ANS: C

Secondary infections, such as oral thrush, genital and anal pruritus, and vaginitis, can occur with prolonged use of broad-spectrum antibiotics. Secondary infections result when normal flora are eliminated, which causes disease-producing microorganisms to multiply. Cross sensitivities develop during repeat exposures, not over a prolonged period.

Immunosuppression does not develop over a prolonged interval of administration. Immunity is not produced by exposure to antibiotics.

DIF: Cognitive Level: Knowledge REF: p. 726 OBJ: 2 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Infection 7. A patient is admitted with glomerulonephritis. IV gentamicin therapy is started after cultures

indicate gram-negative bacilli in the blood. The patient also receives IV furosemide (Lasix).

Which organ monitored for signs and symptoms of toxicity? a. Kidneys b. Pancreas c. Liver d. Brain ANS: A

The results of urinalysis and kidney function tests should be closely monitored when a patient is on aminoglycoside therapy. Patients also receiving cephalosporins, enflurane, methoxyflurane, vancomycin, and diuretics, when combined with aminoglycosides, have a greater potential for nephrotoxicity. The pancreas is not vulnerable to damage from aminoglycosides. Bone marrow suppression is a result of toxicity from treatment with chloramphenicol. Central nervous system toxicities may result from toxic effects of treatment with aminoglycosides but are not related to interactions between the antibiotic and diuretics.

DIF: Cognitive Level: Comprehension REF: p. 729 OBJ: 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety 8. Which drug is the cornerstone of treatment for prophylaxis and treatment of tuberculosis

(TB)? a. Amphotericin B (Abelcet) b. Streptomycin (Streptomycin) c. Isoniazid (Nydrazid) d. Acyclovir (Zovirax) ANS: C

Isoniazid has been the mainstay for years in the treatment and prevention of TB. The mechanism of action of isoniazid is not fully known. Isoniazid appears to disrupt the Mycobacterium tuberculosis cell wall and inhibit replication. Amphotericin B is used in the treatment of fungal infections. Streptomycin is an aminoglycoside used to treat bacterial infections. Acyclovir is used in the treatment of viral infections associated with herpes simplex virus.

DIF: Cognitive Level: Comprehension REF: p. 749 OBJ: 4 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Evaluation CON: Clinical Judgment 9. Which drug is incompatible with heparin? a. Gentamicin b. Ampicillin (Unasyn) c. Ticarcillin (Timentin) d. Ciprofloxacin (Cipro) ANS: A

Gentamicin is incompatible with heparin. Ampicillin, ticarcillin, and ciprofloxacin are compatible with heparin.

DIF: Cognitive Level: Knowledge REF: p. 729 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Safety 10. What adverse effect may manifest as dizziness, tinnitus, and progressive hearing loss? a. Ear infection b. Drug allergy c. Ototoxicity d. Idiosyncratic reaction ANS: C

Damage to the eighth cranial nerve (ototoxicity) can occur from drug therapy, particularly from aminoglycosides. This may initially be manifested by dizziness, tinnitus, and progressive hearing loss. Ear infection is not an adverse effect of drug therapy. Drug allergy is not manifested by hearing loss. Idiosyncratic reaction to a medication is an unusual, unpredictable response specific to a particular person. Unlike allergy, it can occur on first exposure to the medication; unlike an adverse effect, it only affects very few individuals, possibly with a genetic or metabolic abnormality.

DIF: Cognitive Level: Comprehension REF: p. 727 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Sensory Perception 11. Which adverse effect will the nurse will monitor on patients prescribed cephalosporins and

loop diuretics? a. Hepatic toxicity b. Ototoxicity c. Nephrotoxicity d. Splenotoxicity ANS: C

Patients receiving cephalosporins, aminoglycosides, polymyxin B, vancomycin, and loop diuretics concurrently should be assessed for signs of nephrotoxicity. Urinalysis and kidney function tests should be monitored for abnormal results. Cephalosporins are unlikely to cause liver toxicity, ototoxicity, or spleen toxicity.

DIF: Cognitive Level: Comprehension

REF: p. 726

OBJ: 3

NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety 12. The nurse is caring for a patient being treated with an antimicrobial agent for the diagnosis of

a sexually transmitted infection. Which statement made by the patient shows a need for further education? a. ―I will use a barrier method when having sexual intercourse during therapy.‖ b. ―I will increase fluid intake to 2000 to 3000 mL/day.‖ c. ―I will increase protein in my diet.‖ d. ―I will rest frequently.‖ ANS: A

Patients should be instructed to refrain from sexual intercourse during therapy for sexually transmitted infections. Fluids should be increased to 2000 to 3000 mL/day, protein should be increased, and adequate rest should be encouraged.

DIF: Cognitive Level: Application REF: p. 728 OBJ: 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Patient Education | Health Promotion 13. Which patient can safely be treated with a fluoroquinolone medication? a. A 40 year old on steroid therapy b. A 15 year old with a sore throat c. A 70 year old with a gait abnormality d. A 30 year old with a fractured tibia ANS: D

Fluoroquinolones are safe to prescribe for a 30 year old with a fractured tibia.

Fluoroquinolones should not be prescribed for patients taking corticosteroids, patients younger than 18 years, or patients older than 60 years.

DIF: Cognitive Level: Analysis REF: p. 743 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment | NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment MULTIPLE RESPONSE 1. An older adult with a history of asthma, rhinitis, and no known drug allergies has been

admitted to receive IV antimicrobial therapy for bronchitis. The patient has received the oral form of the antimicrobial agent in the past. Which factors increase the risk for an allergic reaction? (Select all that apply.) a. Medical history of asthma b. The patient‘s age c. IV antimicrobial therapy d. Medical history of rhinitis e. Subsequent use of the same antimicrobial therapy ANS: A, D, E

Patients with a history of asthma, allergies, or rhinitis should be closely monitored for possible allergic reaction. Subsequent use of the same antimicrobial therapy may only pose a risk if a reaction occurred with the first administration of the drug; in this case, repeat exposures to a previously sensitized substance can be fatal. Older adults, because of physiologic changes of aging, require close observation for therapeutic response and drug toxicity, but not necessarily for allergic reaction. The route of administration does not increase the risk of an allergic reaction.

DIF: Cognitive Level: Comprehension REF: p. 726 OBJ: 2 | 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 2. A patient has been receiving home healthcare and IV antimicrobial therapy for osteomyelitis

(infection of the bone) of the lower right leg for the past 4 weeks. Which assessment(s) will evaluate the effectiveness of the antimicrobial agent? (Select all that apply.) a. Pain of the right leg b. Patient temperature c. Presence of edema, redness, or swelling in the right lower leg d. Culture and sensitivity parameters at the drug completion e. Complete blood count (CBC) and sedimentation rate laboratory values ANS: A, B, C, E

Ongoing evaluation of treatment effectiveness includes assessing for pain of the affected leg, monitoring the patient‘s temperature, observing the affected extremity for decreased signs of infection (including reduced swelling, wound discharge, and redness), and monitoring the CBC and sedimentation rate through regular laboratory data. Culture and sensitivity testing should be completed before therapy to determine the most effective drug for therapy.

DIF: Cognitive Level: Application REF: p. 726 | p. 727 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Infection 3. Which drugs may reach toxic blood levels if administered with macrolide antibiotics? (Select

all that apply.) a. Benzodiazepines b. Digoxin c. NSAIDs d. HMG-CoA reductase inhibitors e. Diuretics f. Theophylline ANS: A, B, D, F

Macrolide antibiotics may inhibit the metabolism of benzodiazepines, digoxin, HMG-CoA reductase inhibitors, and theophylline, causing accumulation and potential toxicity. NSAIDs and diuretics are not inhibited by macrolide antibiotics.

DIF: Cognitive Level: Comprehension REF: p. 738 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 3 CON: Clinical Judgment | Safety

4. The nurse is planning to administer an ertapenem IV to a patient in the intensive care unit.

Which solution should the nurse use when preparing to reconstitute this medication? (Select all that apply.) a. Water b. Bacteriostatic water c. 0.9% sodium chloride d. 0.45% dextrose e. 1% lidocaine ANS: A, B, C

Ertapenem for IV use should be reconstituted with water for injection, bacteriostatic water for injection, or 0.9% sodium chloride (normal saline) for injection. Ertapenem should not be reconstituted with dextrose solutions or 1% lidocaine injection.

DIF: Cognitive Level: Application REF: p. 731 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation

OBJ: 3 CON: Clinical Judgment | Safety

Chapter 46: Nutrition Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which meal contains the best sources of dietary fiber? a. Eggs, bacon, orange juice b. Salad, whole wheat toast, sliced peach c. Roast beef, mashed potatoes with gravy, corn, milk d. Grilled hamburger on a bun, fresh carrot sticks, potato chips ANS: B

Good dietary sources of fiber include fresh fruits, vegetables, and whole-grain foods. There is little fiber in eggs, bacon, and orange juice and much fat and sugar. Although there is fiber in the menu of roast beef, mashed potatoes, corn, and milk as well as a hamburger on a bun, carrot sticks, and potato chips, these are not the best sources of dietary fiber.

DIF: Cognitive Level: Application REF: p. 778 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Nutrition 2. A patient who is 8 weeks‘ postpartum would like to begin a moderate intensity exercise

program to lose the remaining 20 lb she gained during her pregnancy. Which exercise regimen will the nurse recommend to accomplish this goal best? a. Walking 2 miles daily in 1 hour, four times weekly b. Jogging 4 miles in 20 minutes, three times weekly c. Walking 4 miles in 1 hour daily d. Jogging 2 miles in 20 minutes, twice weekly ANS: C

According to the National Academy of Sciences, a moderate intensity physical activity would include walking at a rate of 4 to 5 miles/hr four to seven times weekly. Walking 2 miles daily in 1 hour four times weekly is below a moderate level of activity. Jogging 4 miles in 20 minutes three times weekly and jogging 2 miles in 20 minutes twice weekly is beyond a moderate level of activity.

DIF: Cognitive Level: Application REF: p. 781 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Patient Education

OBJ: N/A

3. Which food is a good source of vitamin A? a. Sweet potatoes b. Apples c. Bananas d. Whole-grain bread ANS: A

Vegetables and fruits that are orange (sweet potatoes, cantaloupe, and carrots) are concentrated with carotene and are a good source of vitamin A. Apples are a good source of soluble and insoluble fiber. Bananas are a good source of fiber, potassium, and vitamin C. Whole-grain bread is a good source of vitamin E and fiber.

DIF: Cognitive Level: Comprehension REF: p. 779 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Nutrition | Health Promotion 4. Which dietary fats are cardioprotective? a. Monounsaturated b. Polyunsaturated c. Saturated d. Trans ANS: A

Monounsaturated fats decrease low-density lipoprotein (LDL) and increase high-density lipoprotein (HDL) and are considered to be cardioprotective. Polyunsaturated fats also lower LDL and raise HDL but are not considered to be cardioprotective. Saturated fats raise both LDL and HDL and are thought to increase atherosclerotic plaque formation in the arteries.

Trans fats may induce more heart disease than saturated fats because in addition to raising LDL cholesterol, trans fats decrease HDL cholesterol and increase triglycerides, as well as another undesirable blood fat, lipoprotein.

DIF: Cognitive Level: Knowledge REF: p. 778 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Nutrition | Health Promotion 5. A patient is receiving continuous tube feedings at 100 mL/hr. At 1400, the nurse determines

that there is 175 mL of residual volume. Which action will the nurse take? a. Continue the feedings as ordered. b. Reduce the feeding by 50%. c. Stop the feeding and notify the healthcare provider.

d. Aspirate and dispose of the residual and restart the feeding.

ANS: C

When the residual volume of a tube feeding exceeds 100 mL (or the limit set by the healthcare provider), the tube feeding is stopped and the residual volume is rechecked within 1 hour.

When the residual volume has returned to the limits set by the healthcare provider, it is restarted. Because the residual amount already exceeds the recommended amount, the feeding should not continue. Infusion rate should not be changed without an order from the healthcare provider.

DIF: Cognitive Level: Application REF: p. 783 OBJ: 5 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Nutrition | Safety 6. Which term identifies the average daily dietary intake level sufficient to meet the nutrient

requirements of most healthy individuals in a group? a. Dietary Reference Intake (DRI) b. Tolerable Upper Intake Level (UL) c. Estimated Average Requirements (EAR) d. Adequate Intake (AI) ANS: A

The Recommended Dietary Allowance (RDA) table lists the average daily dietary intake level that is sufficient to meet the nutrient requirements of almost all (97% to 98%) healthy individuals in a group. RDAs are goals in meeting nutritional needs. The UL is the highest level of daily nutrient intake that is likely to pose no risk of adverse health effects to almost all individuals in the general population. The EAR is a nutrient intake value that is estimated to meet the requirement of half of the healthy individuals in a group. The AI is a value based on observed or experimentally determined approximations of nutrient intake by a group of healthy people. The AI is used when the RDA cannot be determined.

DIF: Cognitive Level: Knowledge REF: p. 775 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Nutrition | Health Promotion 7. Which term describes a macronutrient that is a separate factor necessary for complete

nutrition and wellness? a. Phytochemical b. Trace mineral c. Fiber d. A vitamin ANS: C

Macronutrients are essential chemical elements needed by all life in large quantities for normal function. Dietary fiber is derived from plant sources and consists of indigestible carbohydrates and lignin and digestible macronutrients (carbohydrates, proteins), such as cereal brans, sweet potatoes, and legumes, which contribute to overall nutrition. Another category of fiber is functional fiber, which consists of indigestible carbohydrates that have a beneficial physiologic effect on humans. Phytochemicals, minerals, and vitamins are micronutrients.

DIF: Cognitive Level: Knowledge REF: p. 777 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Nutrition | Health Promotion 8. Which diagnosis indicates the need for a patient to follow the DASH diet? a. Diabetes b. Hypertension c. Arthritis d. Seizure disorder ANS: B

DASH stands for Dietary Approaches to Stop Hypertension.

DIF: Cognitive Level: Knowledge REF: p. 772 OBJ: N/A NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Nutrition | Health Promotion | Patient Education 9. A patient presents at the physician‘s office with reports of frequent nosebleeds and delayed

clotting. The physician diagnoses this patient with a vitamin deficiency. Which vitamin in high consumption will treat this type of deficiency? a. C b. D c. K d. A ANS: C

Symptoms of bleeding and/or delayed clotting implicate a vitamin K deficiency.

DIF: Cognitive Level: Knowledge REF: p. 779 OBJ: 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Planning CON: Clinical Judgment | Nutrition | Health Promotion | Clotting | Patient Education MULTIPLE RESPONSE 1. Which nutrient(s) provide(s) energy sources for body activities and metabolism? (Select all

that apply.) a. Protein b. Fat c. Carbohydrate d. Minerals e. Vitamins ANS: A, B, C

The macronutrients protein, fat, and carbohydrate are primary energy sources required for balanced metabolism. Minerals and vitamins are not primary sources of energy for the body.

DIF: Cognitive Level: Knowledge REF: p. 778 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Nutrition | Health Promotion

2. Which action(s) will the nurse perform when a patient is receiving total parenteral nutrition?

(Select all that apply.) a. Assess for electrolyte imbalance. b. Check residual volume qid. c. Position the patient in a high Fowler‘s position. d. Monitor blood glucose levels. e. Discard the solution every 24 hours.

ANS: A, D, E

Electrolytes are monitored during parenteral nutrition. Hyperglycemia may develop and therefore should be monitored. Solutions are discarded every 24 hours. Checking residual volume qid is not an accurate nursing action. Positioning the patient in a high Fowler‘s position is not necessary for parenteral nutrition.

DIF: Cognitive Level: Application REF: p. 788 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Nutrition | Safety

OBJ: 5

3. Which explanation(s) by the nurse is accurate regarding fiber intake? (Select all that apply.) a. It adds bulk to fecal content. b. It enhances gastric emptying. c. It decreases blood cholesterol concentration. d. It decreases postprandial blood glucose concentration. e. It stimulates the appetite.

ANS: A, C, D

Functional fibers such as psyllium add bulk to fecal contents. Fibers can reduce the absorption of dietary fat and cholesterol as well as enterohepatic recirculation of cholesterol and bile acids. This may reduce blood cholesterol concentration. In addition, functional fibers delay gastric emptying, which reduces postprandial blood concentration, potentially preventing excessive insulin secretion and insulin sensitivity. Fibers delay gastric emptying. Functional fibers assist with weight control because they provide a sense of fullness and satiety.

DIF: Cognitive Level: Comprehension REF: p. 778 OBJ: 1 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Planning CON: Clinical Judgment | Nutrition | Health Promotion | Patient Education 4. Which sugar can be directly absorbed from the GI tract into the bloodstream? (Select all that

apply.) a. Glucose b. Sucrose c. Fructose d. Galactose e. Lactose f. Maltose ANS: A, C, D

Monosaccharides, such as glucose (also known as dextrose), fructose, and galactose, are the only sugars that can be absorbed directly from the gastrointestinal tract into the blood.

Disaccharides, such as sucrose (common table sugar), lactose, and maltose, are the most common sugars in foods but must be metabolized to monosaccharides before being absorbed into the bloodstream.

DIF: Cognitive Level: Knowledge REF: p. 777 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Nutrition | Health Promotion 5. Which rationale explains how essential fatty acids are used in the body? (Select all that

apply.) a. Build cell membranes b. Produce energy c. Produce prostaglandin d. Catalyze metabolic reactions e. Eicosanoid production f. Stimulate growth hormone ANS: A, C, E

Essential fatty acids are required for cell membrane structure, prostaglandin production, and eicosanoid production. Essential fatty acids are not a source of energy, do not catalyze metabolic reactions, and do not stimulate growth hormone.

DIF: Cognitive Level: Comprehension REF: p. 778 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Nutrition | Health Promotion 6. A patient is being treated for symptoms of alcohol withdrawal and has been identified to have

a thiamine deficiency. Which assessment(s) will be the focus when performing physical assessment on this patient? (Select all that apply.) a. Level of consciousness b. Cardiac status c. Sensitivity to light d. Risk for diarrhea e. Nutrition status ANS: A, B, E

Signs and symptoms of thiamine deficiency include anorexia, constipation, indigestion, confusion, edema, muscle weakness, cardiomegaly, and heart failure. Assessment will focus on level of consciousness, cardiac status, and nutrition status. Photophobia and diarrhea are not symptoms related to thiamine deficiency.

DIF: Cognitive Level: Application REF: p. 789 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Nutrition | Safety | Addiction

Chapter 47: Herbal and Dietary Supplement Therapy Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE

1. Which rationale explains what black cohosh is used for? a. Prevents miscarriage during the first trimester b. Reduces symptoms of premenstrual syndrome c. Provides antispasmodic activity of the gastrointestinal (GI) system d. Controls migraine headaches ANS: B

Black cohosh is used to reduce symptoms of premenstrual syndrome, dysmenorrhea, and menopause. Therapy is not recommended for longer than 6 months. Because of its effect of relaxing the uterus, black cohosh is not used in pregnant women. Black cohosh does not affect the GI system or relieve migraines.

DIF: Cognitive Level: Comprehension REF: p. 795 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Health Promotion

OBJ: 1

2. Which herbal medicine may improve a patient‘s short-term memory loss and cognitive

function? a. Ginger b. Green tea c. Feverfew d. Ginkgo biloba extract ANS: D

Ginkgo biloba extract is used primarily for increasing cerebral blood flow, particularly in geriatric patients. Conditions treated are short-term memory loss, headache, dizziness, tinnitus, and emotional instability with anxiety. Ginger is used to relieve nausea. Green tea has antioxidant effects. Feverfew is used to relieve migraines.

DIF: Cognitive Level: Knowledge REF: p. 798 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Health Promotion | Cognition | Perfusion 3. Which statement about dietary supplements is true? a. Dietary supplements are considered safe and effective. b. Dietary supplements have not been tested for safety or efficacy. c. There are no serious adverse effects to taking dietary supplements. d. Dietary supplements have full FDA and USP approval.

ANS: B

Labels and advertisements of dietary supplements must contain a statement that the product has not yet been evaluated by the FDA for the treatment, cure, or prevention of disease.

Legally, dietary supplements are not required to be safe and effective, and unfounded claims of therapeutic benefits abound. There can be serious adverse effects when taking dietary supplements. Dietary supplements are not fully approved by the FDA or the United States Pharmacopeia (USP).

DIF: Cognitive Level: Comprehension REF: p. 792 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment

TOP: Nursing Process Step: Evaluation

CON: Clinical Judgment | Safety

4. Which dietary supplement should be used with extreme caution if the patient is on a platelet

inhibitor? a. Aloe b. Ephedra c. Green tea d. Garlic ANS: D

Garlic reduces platelet aggregation and should be used with extreme caution in patients receiving platelet inhibitors (e.g., aspirin, ticlopidine, dipyridamole, clopidogrel).

DIF: Cognitive Level: Comprehension REF: p. 797 OBJ: 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety | Clotting 5. Which medical issue is St. John‘s wort used to treat? a. Rheumatoid arthritis b. Asthma c. Depression d. Viral infections ANS: C

St. John‘s wort is used to treat mild depression and heal wounds. The action of St. John‘s wort is unknown. Studies have shown a prolonged effect of serotonin, dopamine, and norepinephrine as a result of decreased reuptake. Aloe is used to treat arthritis. Ephedra is used to treat asthma. Goldenseal is used to treat viral infections.

DIF: Cognitive Level: Knowledge REF: p. 800 NAT: NCLEX Client Needs Category: Psychological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Health Promotion | Mood and Affect

OBJ: 1

6. Which therapeutic effect applies to the use of valerian? a. Lower high-density lipoproteins (HDLs) and raise low-density lipoprotein (LDLs). b. Prevent infection. c. Promote relaxation and sleep. d. Elevate mood.

ANS: C

Valerian has been used for more than 1000 years as a mild tranquilizer. Valerian is used for restlessness and may promote sleep. Valerian does not affect cholesterol levels, prevent infection, or affect mood.

DIF: Cognitive Level: Comprehension REF: p. 801 OBJ: 1 NAT: NCLEX Client Needs Category: Psychological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Health Promotion | Sleep 7. Which herb is used to stimulate the innate immune system? a. Aloe b. Echinacea

c. Chamomile d. Ginger ANS: B

Echinacea is a nonspecific stimulator of the innate (nonspecific) immune system. It stimulates phagocytosis and effector cell activity. There is an increased release of tumor necrosis factors and interferons from macrophages and T lymphocytes, which increases the body‘s resistance to bacterial and viral infection. It may have anti-inflammatory effects by inhibiting hyaluronidase, a potent inflammatory. Aloe gel has been marketed for topical use to treat pain, inflammation, and itching and as a healing agent for sunburn, skin ulcers, psoriasis, and frostbite. Chamomile is used as a digestive aid for bloating and as an antispasmodic and anti-inflammatory in the GI tract, an antispasmodic for menstrual cramps, an anti-inflammatory for skin irritation, and a mouthwash for minor mouth irritation or gum infections. Ginger has been used for centuries to alleviate nausea and vomiting from a variety of causes. It is thought to act as an antiemetic by increasing gastroduodenal motility and by blocking serotonin receptors that, when stimulated, may trigger nausea and vomiting.

DIF: Cognitive Level: Knowledge REF: p. 796 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Health Promotion | Immunity

OBJ: 1

8. Which prescribed medication would alert the nurse to educate the patient about using Ginkgo

biloba cautiously? a. Antiemetics b. Anti-inflammatories c. Anticoagulants d. Antibiotics ANS: C

Ginkgolides inhibit platelet activating factor, inhibiting platelet aggregation. Ginkgo does not interact with antiemetics, anti-inflammatories, or antibiotics.

DIF: Cognitive Level: Comprehension REF: p. 798 | p. 799 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Health Promotion | Safety | Clotting | Patient Education 9. A patient diagnosed with diabetes, hypertension, chronic obstructive pulmonary disease, and

angina reports to the nurse that she is taking an aloe juice drink to treat constipation. Which potential adverse reaction will the nurse prioritize when assessing this patient? a. Pulse rate b. Blood pressure c. Lung sounds d. Blood glucose monitoring ANS: D

Blood glucose would be the priority because when aloe is taken orally, it may have hypoglycemic effects.

DIF: Cognitive Level: Application REF: p. 795 NAT: NCLEX Client Needs Category: Physiological Integrity

OBJ: 2

TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Health Promotion | Safety | Glucose Regulation 10. The nurse is caring for a 36-year-old patient newly diagnosed with multiple sclerosis (MS).

The patient asks if he can continue to take echinacea to help boost his immune system. Which response is best when the patient asks if they can continue to take echinacea? a. ―Limit use to no more than 8 weeks at a time.‖ b. ―Echinacea use is not recommended for patients with autoimmune diseases.‖ c. ―What other medications are you taking?‖ d. ―That is a decision that you will need to make independently.‖ ANS: B

Because echinacea appears to be an immunomodulator, it is not recommended for patients with autoimmune diseases, such as MS. DIF: Cognitive Level: Application REF: p. 796 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Immunity | Patient Education MULTIPLE RESPONSE 1. Which condition(s) has aloe gel been marketed to treat? (Select all that apply.) a. Sunburn b. Psoriasis c. Migraine headaches d. Pain and inflammation e. Itching ANS: A, B, D, E

Aloe gel may be used topically as a healing agent for sunburn and frostbite; for treatment of psoriasis, skin ulcers, pain, and inflammation; and for topical use to relieve itching. Aloe gel is not used to treat migraine headaches.

DIF: Cognitive Level: Knowledge REF: p. 795 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Health Promotion | Tissue Integrity | Pain 2. Which symptom(s) would be consistent with a paradoxical response associated with

melatonin use? (Select all that apply.) a. Drowsiness b. Agitation c. Insomnia d. Poor concentration e. Jet lag ANS: B, C

Paradoxical, or opposite, responses would include agitation and insomnia. Melatonin causes drowsiness and poor concentration, which are not paradoxical. Melatonin is best known as a sleep aid and treatment for jet lag.

DIF: Cognitive Level: Comprehension REF: p. 805 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety | Sleep | Mood and Affect

OBJ: 1

3. A high school male athlete reports taking creatine supplements to enhance athletic

performance and bulk up his muscles. Which important teaching point(s) and/or recommendation(s) should be made for this supplement? (Select all that apply.) a. Adverse effects may include muscle cramping, dehydration, GI bloating, and diarrhea. b. Inform the healthcare provider of usage, should future nephrotoxic medicines be prescribed. c. It is important to limit fluid. d. Creatine causes a weight gain of 3 to 6 lb because of water retention. e. Recommended dosage is 5 to 6 g four times daily for 5 to 7 days, followed by doses of 2 g/day.

ANS: A, B, D, E

Adverse effects of creatine may include muscle cramping, dehydration, GI bloating, and diarrhea. Because creatine is nephrotoxic, the addition of another drug with this effect could produce serious renal complications. Cell volumization occurs because of a process linked to increased muscle protein synthesis. Recommended dosages are a loading dose of 5 to 6 g four times daily for 5 to 7 days, followed by doses of 2 g/day to maintain elevated creatine concentrations in the muscle. Restricting fluids is not recommended.

DIF: Cognitive Level: Comprehension REF: p. 803 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Health Promotion | Nutrition | Safety | Fluid and Electrolytes | Patient Education 4. A patient calls inquiring about herbal treatment of hypercholesterolemia and other

nonpharmaceutical measures to lower his cholesterol level. Which important concept(s) should be included in the response to this patient? (Select all that apply.) a. Maintain daily dose of black cohosh. b. Drink one to four cups of green tea daily. c. Ingest one fresh clove of garlic daily. d. Maintain daily aspirin dose. e. Avoid concurrent use of garlic with ginkgo, ginger, feverfew, and ginseng.

ANS: B, C, E

Green tea has been shown to lower cholesterol, triglycerides, and low-density lipoprotein (LDL) and to raise high-density lipoprotein (HDL); moderate consumption of one to four cups daily appears to provide therapeutic benefits. One fresh clove of garlic daily, or a daily dose of 8 mg of Allium, is the current dosage recommendation to treat hypercholesterolemia. Garlic reduces platelet aggregation and should be used with caution in patients receiving platelet inhibitors, anticoagulants, and herbal medicines (e.g., ginkgo, ginger, feverfew, ginseng).

Black cohosh is used to reduce symptoms of premenstrual syndrome, dysmenorrhea, and menopause. Aspirin is not taken for control of hyperlipidemia; discontinuation of aspirin therapy for other indications should be only with the direction of the healthcare provider.

DIF: Cognitive Level: Comprehension REF: p. 797 | p. 798 | p. 800 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Health Promotion | Nutrition | Patient Education 5. Which effect(s) can be attributed to green tea? (Select all that apply.) a. Lower cholesterol b. Lower triglycerides and LDLs c. Raise HDLs d. Lower blood glucose e. Preventing calcium loss f. Preventing viral infection ANS: A, B, C

Green tea has been shown to lower cholesterol, triglycerides, and LDL and to raise HDL. Green tea does not affect blood glucose or prevent loss of calcium or viral infections.

DIF: Cognitive Level: Comprehension REF: p. 800 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Health Promotion | Nutrition 6. Which information should be conveyed to a patient regarding the use of the supplement

ginseng? (Select all that apply.) a. Research has confirmed that ginseng increases the body‘s resistance to stress. b. Ginseng is available in tablet form. c. Insomnia can result from ginseng intake. d. Ginseng is an aphrodisiac. e. Ginseng may affect blood coagulation.

ANS: B, C, E

Ginseng is available in tablet form. Insomnia can result from ginseng intake. Ginseng may affect blood coagulation. Very few scientific studies have been completed on ginseng.

Research has not confirmed that it increases the body‘s resistance to stress. There is no scientific basis for the claim that ginseng is an aphrodisiac.

DIF: Cognitive Level: Comprehension REF: p. 799 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Health Promotion | Safety | Patient Education | Clotting

Chapter 48: Substance Abuse Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which screening tests would be appropriate to use on a 16-year-old referred to the community

mental health center following legal charges of driving under the influence? a. Drug Abuse Screening Test (DAST) b. Adolescent Alcohol Involvement Scale (AAIS) c. Adolescent Drug Abuse Diagnosis (ADAD)

d. Minnesota Multiphasic Personality Inventory (MMPI 2) ANS: B

The adolescent patient has legal problems associated with alcohol use. The AAIS screening instrument would be appropriate to use. DAST is a comprehensive screening and assessment instrument. ADAD is an adolescent drug abuse diagnosis instrument. MMPI is a personality inventory.

DIF: Cognitive Level: Comprehension REF: p. 816 OBJ: 2 NAT: NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Addiction 2. A patient admitted 48 hours ago has a diagnosis of gastrointestinal (GI) bleeding and is

receiving IV hydration and transfusions. When making rounds, the nurse observes the patient to be having a tonic-clonic seizure. Which cause may apply to this seizure? a. Low blood counts as a result of bleeding b. Alcohol withdrawal c. Alkalosis d. Inadequate nutrition ANS: B

Alcohol withdrawal symptoms can begin within a few hours of discontinuation of drinking and may continue for 3 to 10 days. Withdrawal symptoms may be severe and include visual and auditory hallucinations and tonic-clonic seizures. The patient‘s admitting diagnosis, GI bleeding, may be associated with alcohol abuse. Denial is a common symptom associated with alcoholism, and the patient may not have been honest about alcohol intake when the healthcare provider took the history on admission. History may be obtained from the patient‘s family or significant other. It is unlikely that the blood loss is significant enough to induce seizures. Alkalosis is not likely the cause of seizures in this case; the patient is more likely to be acidotic from the combined dehydration and withdrawal. Common causes in the setting of alcohol withdrawal include alcoholic ketoacidosis and ingestion of alcohols or medications that result in metabolic acidosis (e.g., methanol, ethylene glycol, salicylate). Inadequate nutrition is not likely to cause seizures in this patient.

DIF: Cognitive Level: Comprehension REF: p. 817 OBJ: 4 NAT: NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Addiction 3. Which information is most important when suspecting that a colleague is abusing alcohol? a. ―Good faith‖ reporting is unfaithful to a colleague. b. Reporting will result in loss of the colleague‘s license. c. It is not of concern, and the nurse won‘t be penalized for refusing to get involved. d. State guidelines may mandate to report substance abuse.

ANS: D

In some states, when substance abuse of a colleague is suspected, reporting is mandatory.

Professionals must be loyal to their patients and protect them from harm. ―Good faith‖ reporting should not be viewed as disloyalty to a colleague. Licenses are often not revoked when a colleague self-reports or is reported for substance abuse. Health professionals may be named in a civil lawsuit if they fail to report suspected impairment of another professional.

DIF: Cognitive Level: Comprehension

REF: p. 810 | p. 811

OBJ: 3 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Planning CON: Clinical Judgment | Addiction | Health Care Law 4. Which assessment is correct when a urinalysis is positive for the drug tested? a. Indicates illegal drug use b. Verifies drug dependency c. Is a violation of the individual‘s constitutional rights d. Verifies whether the drug is present in the specimen ANS: D

Positive urinalysis simply indicates the presence of the drug being tested for in the urine specimen. The person may have a prescription for a substance found in the urine or may have been accidentally dosed with it. Presence of the substance in the urine does not indicate dependence because the person may only be an episodic user of the substance. Asking for the person‘s permission to collect a specimen and examine it does not violate the person‘s constitutional rights. The Supreme Court has ruled that drug screening does not violate one‘s constitutional right to privacy or represent an unreasonable search.

DIF: Cognitive Level: Comprehension REF: p. 811 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Addiction 5. Which instruction on what to avoid will be provided to patients on daily disulfiram

(Antabuse)? a. All forms of cough syrup b. Alcohol c. Benzodiazepines d. Aspirin products ANS: B

Disulfiram is used to reduce the desire for alcohol by inducing severe nausea and vomiting when a patient ingests alcohol while on this drug. Reactions can be quite severe, and patients must understand the need to avoid all forms of alcohol while taking this medication. Not all cough syrups contain alcohol. Benzodiazepines and aspirin do not react with disulfiram.

DIF: Cognitive Level: Comprehension REF: p. 818 | p. 819 | p. 827 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Addiction | Safety | Patient Education 6. Which legislation protects individuals who have been successfully rehabilitated from

substance abuse from discrimination related to past addiction? a. Americans with Disabilities Act (ADA) b. National Council on Alcoholism and Drug Dependence c. Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) d. American Medical Association (AMA) ANS: A

Persons dependent on drugs, but who are no longer using drugs illegally and are receiving treatment for chemical dependence, or who have been rehabilitated successfully are protected by the ADA from discrimination on the basis of past drug addiction. The National Council on Alcoholism and Drug Dependence is a voluntary health agency dedicated to educating the public about alcoholism. The ATF is a principal law enforcement agency in the US Department of Justice dedicated to preventing terrorism, reducing violent crime, and protecting the United States. The AMA is a professional organization for physicians.

DIF: Cognitive Level: Comprehension REF: p. 814 OBJ: N/A NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Addiction | Health Care Law 7. Which prescription must be administered before glucose infusions for a patient in alcohol

withdrawal to prevent Wernicke‘s encephalopathy? a. Chlordiazepoxide (Librium) b. Thiamine c. Diazepam (Valium) d. Bromocriptine (Parlodel) ANS: B

Thiamine and multiple vitamins should be administered routinely to patients in alcohol withdrawal. Intravenous fluid therapy for rehydration may be necessary, but thiamine must be administered before glucose infusion to prevent Wernicke‘s encephalopathy. Benzodiazepines are given for treatment of anxiety and seizures associated with alcohol withdrawal.

Bromocriptine is not used to prevent Wernicke‘s encephalopathy.

DIF: Cognitive Level: Comprehension REF: p. 826 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Addiction | Safety

OBJ: 4

8. Which effect will occur if a patient being treated with naltrexone (ReVia) for substance abuse

ingests opioids or alcohol? a. Increased euphoria b. Nausea, vomiting, and diarrhea c. Deep sedation d. An absence of the ―high‖ associated with drugs ANS: D

Naltrexone is an opioid antagonist prescribed to block the pharmacologic effects of the ―high‖ associated with opioids and alcohol. Studies report less alcohol craving and fewer drinking days, especially when naltrexone is combined with psychosocial treatment. Naltrexone prevents the euphoria associated with taking drugs like opioids and alcohol. These are symptoms of taking alcohol in combination with disulfiram (Antabuse). Naltrexone is not sedating.

DIF: Cognitive Level: Comprehension REF: p. 821 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Addiction

9. A patient is admitted into a substance abuse treatment center and is withdrawing from alcohol.

Which statement made by the patient‘s family member shows a need for further education? a. ―Withdrawal symptoms can begin within a few hours of discontinuation of drinking.‖ b. ―Withdrawal symptoms will improve within 24 hours.‖ c. ―Less than 1% of patients develop delirium tremens.‖ d. ―Benzodiazepines are commonly used for detoxification.‖ ANS: B

Withdrawal symptoms may continue for 3 to 10 days. Withdrawal symptoms can begin within a few hours of discontinuation of drinking. Less than 1% of patients develop delirium tremens. Benzodiazepines are commonly used for detoxification.

DIF: Cognitive Level: Comprehension REF: p. 817 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Addiction | Safety | Communication

OBJ: 4

10. The nurse is assisting with the development of care plan for a patient withdrawing from

cocaine. Which problem would be the first priority for this patient? a. Poor nutrition b. Decreased peripheral tissue perfusion c. Fluid volume deficit d. Self-directed violence ANS: D

Depression with suicidal ideation is generally the most serious problem associated with cocaine withdrawal. Altered nutrition, risk for altered peripheral tissue perfusion, and risk for fluid volume deficit are not the priorities for a patient withdrawing from cocaine.

DIF: Cognitive Level: Application REF: p. 823 OBJ: 4 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Diagnosis CON: Clinical Judgment | Addiction | Safety | Interpersonal Violence 11. Which time of day will the nurse plan to provide disulfiram (Antabuse) to a patient in alcohol

rehabilitation? a. Before breakfast b. With lunch c. Before dinner d. At bedtime ANS: D

Disulfiram should be administered at bedtime to avoid the complications of sedative effects.

DIF: Cognitive Level: Application REF: p. 828 OBJ: 4 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Addiction | Safety 12. Which patient assessment will the nurse expect to observe when a patient has ingested alcohol

while on disulfiram (Antabuse)?

a. b. c. d.

Unconsciousness Hypertension GI bleeding Severe vomiting

ANS: D

Severe vomiting occurs when alcohol is ingested while a patient is on disulfiram therapy.

Disulfiram blocks the metabolism of acetaldehyde, a metabolite of alcohol. Elevated levels of acetaldehyde produce a reaction causing nausea, severe vomiting, sweating, throbbing headache, dizziness, blurred vision, and confusion. Disulfiram will not generally cause unconsciousness when alcohol is ingested with it, does not cause hypertension when taken in combination with alcohol, and does not cause GI bleeding.

DIF: Cognitive Level: Comprehension REF: p. 828 OBJ: 4 NAT: NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Addiction 13. Which rationale applies to administering acamprosate (Campral)? a. Withdrawal from alcohol addiction b. Maintenance of sobriety c. Improvement of renal function d. Correction of electrolyte imbalances ANS: B

Acamprosate is used in alcohol rehabilitation programs for chronic alcoholics who want to maintain sobriety. Drugs likely to be given during withdrawal from alcohol addiction include anticonvulsants, thiamine, benzodiazepines, and beta blockers. Acamprosate does not improve renal function. Acamprosate does not correct electrolyte imbalances.

DIF: Cognitive Level: Comprehension REF: p. 826 | p. 827 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Addiction MULTIPLE RESPONSE 1. Which important point(s) of patient education should be included about disulfiram (Antabuse)

therapy? (Select all that apply.) a. The patient should return for liver function tests in 10 to 14 days following initiation of therapy. b. Headache, fatigue, and a metallic taste are common adverse effects that usually resolve. c. Avoid alcohol ingestion to prevent a reaction. d. Carefully read all labels for possible alcohol content, including perfumes and over-the-counter (OTC) medications such as cough syrups. e. Report to the healthcare provider any allergic symptoms, such as hives or pruritus.

ANS: A, B, C, D

Baseline laboratory data include liver function tests and alcohol screening. Headache, fatigue, and a metallic taste are common adverse effects of disulfiram. Disulfiram is a drug used to treat chronic alcoholism that produces a very unpleasant reaction to alcohol. Patients should be instructed to read all labels of topical substances and OTC drugs for alcohol content, as well as avoiding any foods that may be prepared with alcohol. Disulfiram is unlikely to cause allergic reactions.

DIF: Cognitive Level: Comprehension REF: p. 828 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Addiction | Safety | Patient Education 2. A health professional colleague is suspected of having a substance abuse problem because of

the person‘s frequent absenteeism, mood swings when at work, diminished alertness, and poor patient care. Which action(s) will the nurse take? (Select all that apply.) a. Confront the individual. b. Document specific examples of inappropriate actions. c. Avoid assigning this individual to patients with narcotic medication orders or high acuities. d. Notify law enforcement of the suspicions. e. Submit a confidential report to an appropriate supervisor.

ANS: B, E

Observation and documentation are crucial to building a record of repeat instances over time to support the suspicion of impairment. Examples of inappropriate actions need to be well documented over time. An accurate record can also be useful in helping the impaired individual to recognize the problems and submit voluntarily to treatment. If a health professional suspects that a colleague is impaired, a confidential report should be made to an appropriate supervisor familiar with institutional policy. Confronting the individual, avoiding assigning this individual to patients with narcotic medication orders or high acuities, and notifying law enforcement of the suspicions are not appropriate actions to take.

DIF: Cognitive Level: Application REF: p. 811 NAT: NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Addiction | Safety

OBJ: 3

3. Which action(s) will assist in long-term goal attainment and promote abstinence for a patient

that has completed substance abuse treatment for alcoholism? (Select all that apply.) a. Naltrexone therapy b. Regular attendance at NA c. Regular contact with his program sponsor d. Following the 12-step program of AA e. Diazepam therapy to reduce the likelihood of DTs ANS: A, C, D

Treatment may require pharmacologic treatment, such as disulfiram or naltrexone therapy.

Regular contact with a sponsor provides support and continuity in the process of maintaining sobriety. Treatment requires lifelong effort with a combination of psychosocial support; use of the 12-step program will assist the patient in maintaining recovery. NA stands for Narcotics Anonymous; this patient should attend meetings of AA, or Alcoholics Anonymous. Diazepam has a high potential for abuse and should not be used with recovering addicts.

DIF: Cognitive Level: Application REF: p. 818 | p. 819 OBJ: 4 NAT: NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Addiction | Health Promotion 4. Which opioid withdrawal symptom(s) is Clonidine (Catapres) used to treat? (Select all that

apply.) a. Hypertension b. Tremors c. Agitation d. Depression e. Sweating f. Nausea ANS: B, C, E

Clonidine is useful in decreasing tremors, agitation, and sweating associated with opioid withdrawal. Clonidine does not have a hypotensive effect, treat depression, or alleviate nausea.

DIF: Cognitive Level: Comprehension REF: p. 820 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Addiction

OBJ: 4