TEST BANK for Karch’s Focus on Nursing Pharmacology 9th Edition by Rebecca Tucker (Complete 60 Chapt by digitaldownload87

Chapter 1:Introduction to Drugs Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 3, Introduction 1. A nurse working in radiology administers iodine to a client who is having a computed tomography (CT) scan. The nurse working on the oncology unit administers chemotherapy to clients who have cancer. At the Public Health Department, a nurse administers a measles–mumps–rubella (MMR) vaccine to a 14-month-old child as a routine immunization. Which branch of pharmacology best describes the actions of all three nurses? A) pharmacoeconomics B) pharmacotherapeutics C) pharmacodynamics D) pharmacokinetics

Ans: B

Feedback: Pharmacology is the study of the biologic effects of chemicals. Nurses are involved with clinical pharmacology or pharmacotherapeutics, which is a branch of pharmacology that deals with the uses of drugs to treat, prevent, and diagnose disease. The radiology nurse is administering a drug to help diagnose a disease. The oncology nurse is administering a drug to help treat a disease. Pharmacoeconomics includes any costs involved in drug therapy. Pharmacodynamics involves how a drug affects the body, and pharmacokinetics is how the body acts on the body.

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Format: Multiple Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: Legal Regulation of Drugs, 19, Box 1.2 2. The care provider has prescribed intravenous hydromorphone, an opioid, for a client using a client-controlled analgesia (PCA) pump. The nurse is aware that this drug has a high abuse potential. Under what category would hydromorphone be classified? A) schedule I B) schedule II C) schedule III D) shedule IV

Ans: B

Feedback: Opioids with a high abuse potential are classified as schedule II drugs because of severe dependence liability. Schedule I drugs have high abuse potential and no accepted medical use. Schedule III drugs have a lesser abuse potential than schedule II drugs and an accepted medical use. Schedule IV drugs have low abuse potential and limited dependence liability.

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3. When involved in phase III drug evaluation studies, what action should the nurse perform? A) Work with animals which are given experimental drugs. B) Select appropriate clients to be involved in the drug study. C) Monitor and observe clients closely for adverse effects. D) Make decisions that will determine effectiveness of the drug.

Ans: C

Feedback: Phase III studies involve use of a drug in a larger sample of the population. The purpose is to determine the treatment benefit and to monitor side effects that may not have been apparent in the earlier studies. Phase I studies involve healthy human volunteers who are usually paid for their participation. Nurses may observe for adverse effects and toxicity. Nurses may be responsible for helping collect and analyze the information to be shared with the Food and Drug Administration (FDA) but would not conduct research independently because nurses do not prescribe medications. Use of animals in drug testing is done in the preclinical trials. Select clients who are involved in phase II studies have the disease the drug is intended to treat. These clients are monitored closely for drug action and adverse effects.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 22, Legal Regulation of Drugs 4. What concept is prioritized when a provider is considering the substitution of brand name drug with a generic drug? A) bioequivalency B) critical concentration

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C) distribution D) half-life

Ans: A

Feedback: The goal is that the generic medication is bioequivalent (has the same effect on the body) to the brand name medication. Binders used in a generic drug may not be the same as those used in the brand name drug. Therefore, the way the body breaks down and uses the drug may differ, which may eliminate a generic drug substitution. Critical concentration is the amount of a drug that is needed to cause a therapeutic effect and should not differ between generic and brand name medications. Distribution is the phase of pharmacokinetics, which involves the movement of a drug to the body’s tissues and is the same in generic and brand name drugs. A drug’s half-life is the time it takes for the amount of drug to decrease to half the peak level, which should not change when substituting a generic medication.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 23, Legal Regulation of Drugs 5. A nurse is assessing the client’s home medication use. After listening to the client list current medications, the nurse asks what priority question? A) “Do you take any generic medications?” B) “Are any of these medications orphan drugs?” C) “Are these medications safe to take during pregnancy?” D) “Do you take any over-the-counter medications?”

Ans: D

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Feedback: It is important for the nurse to specifically question use of over-the-counter medications because clients may not consider them important. The client is unlikely to know the meaning of “orphan drugs” unless they are a healthcare provider. Safety during pregnancy, use of a generic medication, or classification of orphan drugs are things the client would be unable to answer but could be found in reference books if the nurse wishes to research them.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 2 Page and Header: 5, Introduction 6. What goal should a nurse set when beginning a course on pharmacology for nurses? A) At the completion of the course, the nurse will know everything necessary for safe and effective medication administration. B) At the completion of the course, the nurse will know current pharmacologic therapy and will not require ongoing education for 5 years. C) At the completion of the course, the nurse will know general drug information because the nurse can consult a drug guide for specific drug information. D) At the completion of the course, the nurse will understand each drug action that is associated with each classification of medication.

Ans: C

Feedback: After completing a pharmacology course, nurses will have general drug information needed for safe and effective medication administration but will need to consult a drug guide for specific drug information before administering any medication. Pharmacology is constantly changing, with new drugs entering the market and new uses

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for existing drugs identified. Continuing education in pharmacology is essential to safe practice. Nurses tend to become familiar with the medications they administer most often, but there will always be a need to research new drugs and also those the nurse is not familiar with because no nurse knows all medications.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 19, Safety During Pregnancy, Box 1.1 7. A nurse is instructing a pregnant client concerning the potential risk to their fetus from a pregnancy category D drug. What should the nurse inform the client? A) “Adequate studies in pregnant clients have demonstrated there is no risk to the fetus.” B) “Animal studies have not demonstrated a risk to the fetus, but there have been no adequate studies in pregnant clients.” C) “Animal studies have shown an adverse effect on the fetus, but there are no adequate studies in pregnant clients.” D) “There is evidence of human fetal risk, but the potential benefits from use of the drug may be acceptable despite potential risks.”

Ans: D

Feedback: Category A indicates that adequate studies in pregnant clients have not demonstrated a risk to the fetus in the first trimester or in later trimesters. Category B indicates that animal studies have not demonstrated a risk to the fetus. However, there have not been adequate studies in pregnant clients to demonstrate risk to a fetus during the first trimester of pregnancy and no evidence of risk in later trimesters. Category C indicates that animal studies have shown an adverse effect on the fetus, but no

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adequate studies in humans. Category D reveals evidence of human fetal risk, but the potential benefits from the use of the drugs in pregnant clients may outweigh potential risks.

Format: Multiple Selection Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 4 Page and Header: 23, Legal Regulation of Drugs 8. Discharge planning for clients leaving the hospital should include instructions on the use of over-the-counter (OTC) drugs. Which comments by the client should prompt the nurse to provide additional health education? Select all that apply. A) “OTC drugs are safe and do not cause adverse effects if taken properly.” B) “OTC drugs have been around for years and have not been tested by the Food and Drug Administration (FDA).” C) “OTC drugs are different from any drugs available by prescription and cost less.” D) “OTC drugs could cause serious harm if not taken according to directions.” E) “OTC drugs can often be used as a cost-effective substitute for prescribed drugs.”

Ans: A, B, C, E

Feedback: It is important to follow package directions because OTCs are medications that can cause serious harm if not taken properly. OTCs are drugs that have been determined to be safe when taken as directed; however, all drugs can produce adverse effects even when taken properly. They may have originally been prescription drugs that were tested by the FDA or they may have been grandfathered in when the FDA laws changed. OTC education should always be included as a part of the hospital discharge instructions. Client should not view OTC drugs as being substitutes for prescribed drugs.

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Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 4 Page and Header: 6, Introduction 9. A nurse is unfamiliar with a drug that a client in the community has recently been prescribed. What information source should the nurse consult? A) Drug Facts and Comparisons B) a nurse’s drug guide C) the website www.drugs.com D) the Physicians’ Drug Reference (PDR)

Ans: B

Feedback: A nurse’s drug guide provides nursing implications and client teaching points that are most useful to nurses in addition to need-to-know drug information in a very user-friendly organizational style. Lippincott’s Pocket Drug Guide for Nurses has drug monographs organized alphabetically and includes nursing implications and client teaching points. Numerous other drug handbooks are also on the market and readily available for nurses to use. Although other drug reference books such as Drug Facts and Comparisons and PDR can all provide essential drug information, they will not contain nursing implications and teaching points and can be more difficult to use than nurse’s drug guides. A reputable drug guide is a better source than a consumer website.

Format: Multiple Selection Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand

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Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 5, Introduction 10. A nursing student is preparing to begin a pharmacology course. The student should anticipate what areas of study? Select all that apply. A) chemical pharmacology B) molecular pharmacology C) impact of drugs on the body D) the body’s response to a drug E) unexpected drug effects

Ans: C, D, E

Feedback: Nurses study pharmacology from a pharmacotherapeutic level, which includes the effect of drugs on the body, the body’s response to drugs, and both expected and unexpected drug effects. Chemical and molecular pharmacology are not included in nursing pharmacology courses.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 5, Introduction 11. The nurse is caring for an older adult who needs to know that drugs, even when taken correctly, can produce negative or unexpected effects. The nurse should address what topic during health education? A) teratogenic effects B) toxic effects C) adverse effects

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D) paradoxical effects

Ans: C

Feedback: Negative or unexpected effects are known as adverse or side effects. Teratogenic effects are adverse effects on the fetus and not a likely concern for an older adult. Toxic effects occur when medication is taken in larger than recommended dosages caused by an increase in serum drug levels. Paradoxical effects are drug effects that are the opposite of what is intended.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 5, Introduction 12. The nurse has just administered a client’s medication. What action should the nurse perform next? A) Assess for drug effects. B) Perform a comprehensive health assessment. C) Educate the client about the purpose of the drug. D) Assess for preexisting conditions.

Ans: A

Feedback: After the medication is administered, the nurse assesses the client for drug effects, both therapeutic and adverse. The nurse would assess the client for allergies and preexisting conditions before administering a medication. Assessing for drug effects does not normally necessitate a comprehensive health assessment.

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Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 6, Introduction 13. The nurse receives an order to administer an unfamiliar medication and obtains a nurse’s drug guide published 4 years earlier. What is the nurse’s most prudent action? A) Find a more recent reference source. B) Use the guide if the drug is listed. C) Use the guide because it is less than 6 years old. D) Verify the information in the guide with the pharmacist.

Ans: A

Feedback: The nurse is responsible for all medications administered and must find a recent reference source to ensure the information learned about the medication is correct and current. Using an older drug guide could be dangerous because it would not contain the most up-to-date information. Asking the pharmacist does not guarantee accurate information will be obtained and could harm the client if the information is wrong.

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Page and Header: 5, Introduction 14. The nurse is preparing a client for discharge knowing the client will be selfadministering medication at home. What is the nurse’s most appropriate action? A) Provide the client with the nurse’s contact information for when the client has questions. B) Provide thorough medication teaching about drugs and the drug regimen. C) Advise the use of over-the-counter medications to use to treat potential adverse effects. D) Provide a 2-day supply of medication to take home until prescription is filled.

Ans: B

Feedback: The nurse is responsible for providing thorough medication teaching about drugs and the drug regimen to ensure the client knows how to take the medication and when to notify the provider. The nurse never provides personal contact information to a client. If adverse effects arise, the client is taught to call the healthcare provider and should not self-medicate with over-the-counter drugs, which could mask serious symptoms. The nurse never dispenses medication because it must be properly labeled for home use; this is done by the pharmacy.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Communication and Documentation Objective: 2 Page and Header: 10, Drug Evaluation 15. In response to the client’s question about how to know whether drugs are safe, the nurse explains that all medications in the United States undergo rigorous scientific testing controlled by what organization? A) Food and Drug Administration (FDA)

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B) Drug Enforcement Agency (DEA) C) Centers for Disease Control and Prevention (CDC) D) Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

Ans: A

Feedback: The FDA is responsible for controlling and regulating the development and sale of drugs in the United States, allowing new drugs to enter the market only after being subjected to rigorous scientific testing. The DEA regulates and controls the use of controlled substances. The CDC monitors and responds to infectious diseases. The JCAHO is an accrediting body that inspects acute care facilities to ensure minimum standards are met.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 12, Drug Evaluation 16. The nurse is assisting with a phase I drug study. What potential participant would be most appropriate? A) a 22-year-old male with an unremarkable health history B) a 24-year-old female who takes oral contraceptives C) a 49-year-old female who has completed menopause D) a 17-year-old male who is in good health

Ans: A

Feedback: Phase I drug trials usually involve healthy male volunteers because chemicals may exert an unknown and harmful effect on ova in women, which could

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result in fetal damage when the woman becomes pregnant. Drugs are tested on both men and women, but women must be fully informed of risks and sign a consent stating they understand the potential for birth defects. A 17-year-old would normally be too young to participate.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 11, Drug Evaluation 17. The client tells the nurse about a new drug being tested to treat the disease they are diagnosed with, and asks the nurse whether the doctor can prescribe a medication still in the preclinical phase of testing. What is the nurse’s best response? A) “The doctor would have to complete a great deal of paperwork to get approval to prescribe that drug.” B) “Sometimes pharmaceutical companies are looking for volunteers to test a new drug and the doctor could give them your name.” C) “Drugs in the preclinical phase of testing are only tested on animals and so would not be available to you.” D) “Drugs in the preclinical phase of testing are given only to healthy young men and so would not be available to you.”

Ans: C

Feedback: During the preclinical phase of testing, drugs are tested on animals and are not available to clients. In phase I, the drug is tested on volunteers who are usually healthy young men. It is only in phase III studies that the drug is made available to prescribers who agree to closely monitor clients getting the medication.

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Format: Multiple Selection Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 2 Page and Header: 14, Drug Evaluation 18. The nurse is caring for a client who had a severe, acute, previously unseen adverse effect of a drug in phase III testing. The client asks, “After all the testing done on this drug, didn’t they know this adverse effect could occur?” What are appropriate responses by the nurse? Select all that apply. A) “Pharmaceutical companies sometimes underreport problems to make more money.” B) “Your response to this medication will be reviewed very closely to address possible adverse effects.” C) “Adverse effects are studied to determine whether the disease or the drug was the cause.” D) “The pharmaceutical company weighs the benefits of the drug with the severity of adverse effects.” E) After a drug reaches phase III testing, it is considered an accepted drug and will not be recalled.”

Ans: B, C

Feedback: Researchers observe clients very closely, monitoring them for any adverse effects. Often, participants are asked to keep journals and record any symptoms they experience. Researchers then evaluate the reported effects to determine whether they are caused by the disease or by the drug. It would be both unprofessional and inaccurate to imply that pharmaceutical companies put profit ahead of client concern because lawsuits would remove any potential profit if a drug proves harmful. The FDA is responsible for weighing risk versus benefit in deciding whether to allow the drug to

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move to the next phase of testing. Drugs found to have serious adverse effects can be removed from the market at any time.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Communication and Documentation Objective: 3 Page and Header: 19, Legal Regulation of Drugs 19. The telephone triage nurse receives a call from a client asking for a prescription for an opioid (narcotic) to manage the surgical pain. The nurse explains that opioid prescriptions must be written and cannot be called into the pharmacy. The client says, “Why are opioids so difficult to get a prescription for?” What is the nurse’s best response? A) “The Drug Enforcement Agency (DEA) determines the risk for addiction, and the Food and Drug Administration (FDA) enforces their control.” B) “The increase in the number of drug addicts has made the rules stronger.” C) “The Centers for Disease Control and Prevention (CDC) regulates use of controlled substances to reduce the risk of injury.” D) “Controlled substances like opioids are controlled by the FDA and the DEA.”

Ans: D

Feedback: Controlled substances are controlled by the FDA and the DEA: the DEA enforces control, while the FDA determines abuse potential. Regulations related to controlled substances have remained strict and specific and have not been significantly impacted by substance abusers. The CDC is not involved in control of opioids and other controlled substances.

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Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 3 Page and Header: 19, Legal Regulation of Drugs, Box 1.2 20. The nurse explains the Drug Enforcement Agency’s (DEA’s) schedule of controlled substances to the nursing assistant who asks, “Do you ever get a prescription for schedule I medications?” What is the nurse’s best response? A) “Schedule I medications have no medical use so they are not prescribed.” B) “Schedule I medications have the lowest risk for abuse and do not require a prescription.” C) “Schedule I medications are only prescribed in monitored units for client safety.” D) “Schedule I medications are found in antitussives and antidiarrheals sold over the counter.”

Ans: A

Feedback: Schedule I medications have no medical use and are never prescribed. Schedule II have high abuse potential with severe dependence liability. Schedule III have less abuse potential than schedule II drugs and moderate dependence liability. Schedule IV have less abuse potential than schedule III and limited dependence liability. Schedule V medications have the lowest risk for abuse and are found mostly in antitussives and antidiarrheals, but they are not sold over the counter.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Teaching/Learning Objective: 2 Page and Header: 18, Legal Regulation of Drug, Box 1.1 21. The nurse, working on the maternity unit, receives a call from a pregnant client asking how they can know whether a medication is safe to take while pregnant. What is the nurse’s best response? A) “You can take any drug indicated as a category A.” B) “No medications should be taken during pregnancy.” C) “Never take medication until you receive approval from your healthcare provider.” D) “Most medications are safe but you need to weigh benefit against risk.”

Ans: C

Feedback: The best response to a pregnant client asking about medication usage is to talk with their obstetric practitioner because the best advice will come from someone who knows their health and pregnancy history. While category A drugs have no known risk, they may be contraindicated by the client’s health condition or pregnancy issues, and many pregnant clients would not know what it means to be a category A drug. Medications can be helpful during pregnancy if taken safely and appropriately. Although risk benefit needs to be weighed, it should occur with advice from the obstetric practitioner.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 3 Page and Header: 20, Legal Regulation of Drugs, Box 1.2 22. A client asks the nurse, “What is a Drug Enforcement Agency (DEA) number?” What is the nurse’s best response?

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A) “DEA numbers are given to primary care providers (PCPs) and pharmacists when they register with the DEA to prescribe and dispense controlled substances.” B) “Providers must have a DEA number in order to prescribe any type of medication for clients.” C) “DEA numbers are case numbers given when someone breaks the law involving a controlled substance.” D) “DEA numbers the standardized codes for each drug that is on the market in the United States.”

Ans: A

Feedback: All pharmacists and providers must register with the DEA. They are given numbers that are required before they can dispense or prescribe controlled substances. DEA numbers are only needed when prescribing controlled substances. A DEA number is neither a case number nor a drug code.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 20, Legal Regulation of Drugs 23. The nurse is preparing to move to another state. The nurse should complete which action? A) Become familiar with local policies and procedures for controlled substance administration. B) Obtain local providers’ Drug Enforcement Agency (DEA) number for prescribing controlled substances. C) Become familiar with pregnancy drug categorization system used in the new state. D) Learn about the particular OTC drugs that are for sale in the new state.

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Ans: A Feedback: The nurse needs to learn local policies and procedures for controlled substance administration because they can vary with some local governments more rigorous than others. Nurses do not memorize a provider’s DEA numbers. The DEA is a federal agency that monitors controlled substances in all states. Pregnancy drug categories are standardized nationwide, and there is minimal variation on the availability of OTC drugs.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 21, Legal Regulation of Drugs 24. The client looks at the prescription provided by the doctor and asks the nurse about the notation “DAW.” What implication of this notation should the nurse explain? A) The prescription will be filled once the pharmacy is informed of the prescriber’s DEA number. B) The pharmacy where the client fills the prescription will not substitute a generic drug. C) The drug falls under the purview of the DEA’s Drug Action Watch program. D) The drug is associated with a high risk of adverse effects.

Ans: B

Feedback: DAW stands for “dispense as written” and means that the doctor does not want a generic substituted for the prescribed medication. This is unrelated to the prescriber’s DEA number, and there is no “Drug Action Watch Program.” The drug is not necessarily associated with a high risk of adverse effects. Format: Multiple Choice

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Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 4 Page and Header: 14, Drug Evaluation 25. The nurse is preparing to administer the drug papaverine (Pavabid). What does the nurse identify the name Pavabid as? A) the generic name B) the chemical name C) the brand name D) the chemical and generic name

Ans: C

Feedback: Several clues indicate the brand name including capitalization of the first letter in the name and in parentheses. Generic names are not capitalized; chemical names are descriptions of the chemistry of the medication resulting in complicated names.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 4 Page and Header: 20, Legal Regulation of Drugs 26. The client is prescribed a medication that was just approved by the FDA. The client tells the nurse, “This medication is too expensive. Could the doctor order a generic form of this medication?” What is the nurse’s best response?

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A) “New medications are patented by the manufacturers. A generic is not available.” B) “You can request the generic form but the binder used may make the drug less effective for this medication.” C) “The generic form of the medication would not be any less expensive because this is a relatively new medication.” D) “Generic medications are lower-quality drugs and that would mean you would not be getting the best treatment available.”

Ans: A

Feedback: When a new drug enters the market, it is given a time-limited patent; generic forms of the medication cannot be produced until the patent expires. Because no generic version of this drug will exist because it is so new, it is impossible to predict what binder will be used or what the cost would be.

Format: Multiple Selection Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 4 Page and Header: 22, Legal Regulation of Drugs; Orphan Drugs 27. The nurse learns that a drug needed by the client is classified as an orphan drug. The nurse should recognize what possible characteristics of this drug? Select all that apply. A) The drug is rarely prescribed. B) The drug has dangerous adverse effects. C) The drug treats a rare disease. D) The patent on the medication is still effective. E) It is produced by a company that only manufactures drugs.

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Ans: A, B, C

Feedback: Drugs are classified as orphan drugs when they are not financially viable for a drug company to produce either because of risk for lawsuits about adverse effects or because the drug is not prescribed, which is often seen in rare diagnoses. Generic drugs are not produced until the patent expires, but this has no impact on classifying a particular drug as an orphan drug. Generic drugs are often produced by companies that only manufacture drugs without conducting research, but this has no bearing on the classification of orphan drugs.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 23, Legal Regulation of Drugs 28. While collecting a medication history, the client admits to doubling the recommended dosage of acetaminophen, saying “It’s harmless or they would require a prescription.” What is the nurse’s best response? A) “OTC drugs are serious medications and carry serious risks if not taken as directed.” B) “Taking medications like that is careless and you could cause yourself serious harm if you keep doing it.” C) “Sometimes you need to take more than the package directs to treat the symptoms. It’s important not to do this frequently.” D) “Did you notify your doctor of the increased dosage you were taking?”

Ans: A

Feedback: OTC drugs are no less a medication than prescription drugs and carry the same types of risks for overdosage and toxicity if directions are not followed. Although

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increasing the dosage is careless and dangerous, it is important to use the information as a teaching opportunity rather than scolding the client. Agreeing with the clients or asking them if they talked to the doctor misses the teaching opportunity, which could be harmful for the client.

Format: Multiple Selection Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 5 Page and Header: 23, Legal Regulation of Drugs 29. The client asks the nurse, “Is it safe to take over-the-counter (OTC) medications with prescription medications?” What are appropriate responses by the nurse? Select all that apply. A) “OTC medications can interact with prescription medications.” B) “It is important to tell your doctor all medications you take, including OTC.” C) “OTC medications could mask or hide signs and symptoms of a disease.” D) “You should avoid taking any OTC medication when taking prescription drugs.” E) “Taking OTC medications can make your prescription medication more effective.”

Ans: A, B, C Feedback: OTC medications can interact with prescription medications or other OTC so it is always important to consult your pharmacist and provider for advice. To provide the most accurate instruction, the healthcare provider must know all medications taken including dietary supplements, OTC, and prescription. OTC medications could mask or hide symptoms of a disease so it is always important to consult a health care provider if symptoms persist. OTC medications are not prohibited when taking prescription drugs as long as no drug interaction occurs. How an OTC will impact a prescription medication varies depending on the medications involved, so it is incorrect to say it will make the prescription drug more effective.

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Format: Multiple Selection Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 25, Sources of Drug Information 30. Before administering a prescription medication, the nurse should confirm what information on the drug label? Select all that apply. A) brand name B) generic name C) drug dosage D) expiration date E) adverse effects F) therapeutic effects

Ans: A, B, C, D Feedback: Prescription drug labels will contain the brand name, generic name, drug dosage, and expiration date. Adverse effects and therapeutic uses will not be listed on drug labels.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 25, Sources of Drug Information

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31. The nurse explains that what drug resource book is compiled from package inserts? A) Nurses Drug Guide B) Physicians’ Desk Reference (PDR) C) Drug Facts and Comparisons D) AMA Drug Evaluations

Ans: B

Feedback: The PDR is a compilation of information found on package inserts. The Nurses Drug Guide uses more easily understood language and incorporates nursing considerations and client teaching points. Drug Facts and Comparisons includes cost comparison, often not found in other drug resource guides. The AMA Drug Evaluations is far less biased than the PDR and includes drugs still in the research stage of development.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 27, Sources of Drug Information 32. A client has been prescribed a new medication but is skeptical to begin taking it after reading about potential risks in an online discussion forum. What is the nurse’s best response? A) “It’s excellent that you’re investigating your medications. Can I recommend some useful websites for you?” B) “Just remember that there is a lot of highly inaccurate information on the internet. A lot of the time it’s best to just avoid it.” C) “How did you find that particular discussion forum?”

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D) “Knowledge is power.” “The more information you can get about something as important as your health, the better.”

Ans: A

Feedback: The nurse can promote a therapeutic dialogue by commending the client’s efforts and hopefully directing the client to valid and reliable information sources. The nurse must avoid reprimanding the client. The method by which the client found the discussion forum is not important. The nurse should not suggest that any, and all, information is beneficial or equally valid.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 27, Sources of Drug Information 33. Which journal should the nurse use to best support effective nursing practice? A) American Journal of Nursing B) Medical Letter C) Journal of American Medical Association D) New England Journal of Medicine

Ans: A

Feedback: The American Journal of Nursing offers information on new drugs, drug errors, and nursing implications. While the other options may provide medication-related information, none are as specific to nursing as is the American Journal of Nursing and it’s identified focus on nursing practice.

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Test Generator Questions, Chapter 2, Drugs and the Body Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 22, Pharmacokinetics 1. The nurse is caring for a diverse group of clients. In which client should the nurse assess for an alteration in drug metabolism? A) a 35-year-old woman with cervical cancer B) a 41-year-old man with kidney stones C) a 50-year-old man with cirrhosis of the liver D) a 32-year-old woman with urosepsis

Ans: C

Feedback: The liver is the most important site of drug metabolism. If the liver is not functioning effectively, as in clients with cirrhosis, drugs will not metabolize normally so that toxic levels could develop unless dosage is reduced. A client with cervical cancer or kidney stones would not be expected to have altered ability to metabolize drugs so long as no liver damage existed. Infections such as urosepsis would not have a direct impact on metabolism.

Format: Fill-in-the-Blank Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process

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Objective: 3 Page and Header: 22, Pharmacokinetics; 27, Box 2.2 2. A client presents to the emergency department with a drug level of 50 units/mL. The half-life of this drug is 1 hour. With this drug, concentrations above 25 units/mL are considered toxic, and no more drug is given. How long will it take for the blood level to reach the nontoxic range? Provide your answer measured in minutes.

Ans: 60 minutes

Feedback: Half-life is the time required for the serum concentration of a drug to decrease by 50%. After 1 hour, the serum concentration would be 25 units/mL (50/2) if the body can properly metabolize and excrete the drug.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Page and Header: 28, Factors Influencing Drug Effects; 28, Box 2.3 3. A client has recently moved from Vermont to South Florida. The client presents to the clinic reporting “dizzy spells” and weakness. The client tells the nurse that they have been on the same antihypertensive drug for 6 years, with stable blood pressures and no adverse effects. The clinic nurse knows that one possible reason for the change in the effectiveness of the drug could be what? A) the impact of psychosocial stress associated with moving B) the accumulative effect of the drug if it has been taken for many years C) the impact of the warmer environment on the client’s physical status D) problems with client adherence with the drug regimen while on vacation Ans: C

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Feedback: Antihypertensive drugs work to decrease the blood pressure. When a client goes to a climate that is much warmer than usual, blood vessels dilate and the blood pressure falls. If a client is taking an antihypertensive drug and moves to a warmer climate, there is a chance that the client’s blood pressure will drop too low, resulting in dizziness and feelings of weakness. Even mild dehydration could exacerbate these effects. Most antihypertensives are metabolized and excreted and do not accumulate in the body. Clients must adhere to their drug regimen on vacation, but this client is not on vacation. Psychosocial factors must be considered, but the client is describing a physiological response.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 28, Factors Influencing Drug Effects; 32, Box 2.5 4. The nurse is providing medication teaching for a client. The nurse has asked the client to provide a complete list of medications taken to health care providers. Ensuring this list is complete will have what potential benefit for the client? A) reducing the client’s spending on medications B) protecting the client from possible allergic reactions to medications C) reducing the client’s likelihood of drug–drug interactions D) maintaining a therapeutic serum concentration of the new drug

Ans: C

Feedback: It is important that all health care providers have a complete list of the client’s medications to avoid drug–drug interactions caused by one provider ordering a medication, unaware of another medication the client is taking that could interact with the new prescription. Informing the provider of all medications taken will not reduce

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costs of medications, which is best accomplished by requesting generic medications. Allergies should be disclosed to all health care providers as well, but this is not why it is important to provide a complete list of medications taken. Ensuring that the client’s drug regimen is fully disclosed will not have direct effect on serum concentrations of the new drug.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 20, Pharmacodynamics 5. A client has been prescribed a medication that is known to be a drug agonist. This drug will have what effect? A) It will react with a receptor site on a cell preventing a reaction with another chemical on a different receptor site. B) The drug will interfere with the enzyme systems that act as catalyst for different chemical reactions. C) The drug will interact directly with receptor sites to cause the same activity that a natural chemical would cause at that site. D) It will react with receptor sites to block normal stimulation, producing no effect.

Ans: C

Feedback: Agonists are drugs that produce effects similar to those produced by naturally occurring neurotransmitters, hormones, or other substances found in the body. Noncompetitive antagonists are drugs that react with some receptor sites preventing the reaction of another chemical with a different receptor site. Drug–enzyme interactions interfere with the enzyme systems that stimulate various chemical reactions.

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Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 22, Pharmacokinetics 6. A nurse is caring for a client who has been receiving a drug by the intramuscular route at a dose of 0.25 mg. After discharge, the client will be prescribed the same medication orally at a dose of 2.5 mg. What phenomenon should the nurse describe when explaining the reason for the increased dosage for the oral dose? A) passive diffusion B) active transport C) glomerular filtration D) first-pass effect

Ans: D

Feedback: The first-pass effect involves drugs that are absorbed from the small intestine directly into the portal venous system, which delivers the drug molecules to the liver. After reaching the liver, enzymes break the drug into metabolites, which may become active or may be deactivated and readily excreted from the body. A large percentage of the oral dose is usually destroyed and never reaches tissues. Oral dosages account for the phenomenon to ensure an appropriate amount of the drug in the body to produce a therapeutic action. Passive diffusion is the major process through which drugs are absorbed into the body. Active transport is a process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. Glomerular filtration is the passage of water and water-soluble components from the plasma into the renal tubule.

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Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 4 Page and Header: 28, Factors Influencing Drug Effects 7. A client’s unexpected response to a new medication has been attributed to characteristics of the client’s genetic makeup. What area of study best explains this client’s medication response? A) pharmacotherapeutics B) pharmacodynamics C) pharmacoeconomics D) pharmacogenomics

Ans: D

Feedback: Pharmacogenomics is the area of study that includes mapping of the human genome. In the future, medical care and drug regimens may be personally designed based on a client’s unique genetic makeup. Pharmacotherapeutics is the branch of pharmacology that deals with the uses of drugs to treat, prevent, and diagnose disease. Pharmacodynamics involves how a drug affects the body. Pharmacoeconomics includes the costs involved in drug therapy.

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Page and Header: 22, Pharmacokinetics 8. The serum lithium levels of a client diagnosed with bipolar disorder have risen to the minimum level required to have a therapeutic effect. What term is used to describe this situation? A) critical concentration B) dynamic equilibrium C) a stable half-life D) benefits of active transport

Ans: A

Feedback: A critical concentration of a drug must be present before a reaction occurs within the cells to bring about the desired therapeutic effect. A dynamic equilibrium is obtained from absorption of a drug from the site of drug entry, distribution to the active site, metabolism in the liver, and excretion from the body to have a critical concentration. Active transport is the process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. The half-life of a drug affects the achievement and maintenance of a critical concentration, but this drug level is not the half-life itself.

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C) Assess the client’s knowledge of the medications. D) Identify the client by checking the armband and asking the client’s name.

Ans: B

Feedback: A nurse should first consult a drug guide for interactions when two or more drugs are being given at the same time. After this review, the medication can be administered. The nurse will perform hand hygiene, check for client allergies, and ensure that the right client receives the medication by using two identifiers. It is important to assess clients’ knowledge of their medications, but ensuring compatibility is a priority.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 28, Factors Influencing Drug Effects; 28, Box 2.3 10. The nurse is preparing to administer an intramuscular dose of meperidine to a client in pain. The nurse should identify what factor that will affect the absorption of the drug by this route? A) perfusion of blood to the subcutaneous tissue B) integrity of the client mucous membranes C) environmental temperature D) the amount of adipose tissue that the client has

Ans: C

Feedback: A cold environmental temperature can cause blood vessels to vasoconstrict and decreases absorption or in a hot environment, vasodilate and increase absorption of IM medications. Blood flow to the subcutaneous tissues interferes with subcutaneous

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injection. Intramuscular injections enter muscle, so the amount of adipose tissue that the client has will not have a direct effect on absorption. The condition of mucous membranes can interfere with sublingual (under the tongue) and buccal (in the cheek) administration of drugs.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 20, Pharmacodynamics 11. The client is taking a drug that affects the body by increasing cellular activity. Where does this drug work on the cell? A) receptor sites B) cell membrane C) Golgi body D) endoplasmic reticulum

Ans: A

Feedback: Many drugs are thought to act at specific areas on cell membranes called receptor sites. After the receptor site is activated, this in turn activates the enzyme systems to produce certain effects, such as increased or decreased cellular activity, changes in cell membrane permeability, or alterations in cellular metabolism. Receptor sites are generally located on the outside of cells and allow the drug to bypass the cell membrane. The Golgi body and endoplasmic reticulum are not involved in this process.

Format: Multiple Selection Chapter: 2

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 22, Pharmacokinetics 12. What physiologic processes contribute to the achievement of dynamic equilibrium when a nurse administers a drug? Select all that apply. A) distribution to the site where the drug is active B) biotransformation C) absorption from site where the drug enters the body D) excretion from the body E) interaction with other drugs

Ans: A, B, C, D Feedback: The actual concentration that a drug reaches in the body results from a dynamic equilibrium involving several processes: absorption from the site of entry (can be from the muscle, the gastrointestinal [GI] tract if taken orally, of the subcutaneous tissue if given by that route), distribution to the active site, biotransformation (metabolism) in the liver, and excretion from the body. Interaction with other drugs is not part of the dynamic equilibrium.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 22, Pharmacokinetics 13. A nurse is administering digoxin to a client. To administer medications so that the drug is as effective as possible, the nurse should prioritize what factor?

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A) the client’s preferences B) the process of pharmacokinetics C) educating the client about potential adverse effects D) the client’s culture and ethnicity

Ans: B

Feedback: When administering a drug, the nurse needs to consider the phases of pharmacokinetics so that the drug regimen can be made as effective as possible. The client should be educating about adverse effects, but this action does not directly influence effectiveness. Similarly, the nurse must always consider clients’ preferences, culture, and ethnicity, but these variables are less significant than the broader process of pharmacokinetics.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 22, Pharmacokinetics 14. The processes involved in dynamic equilibrium are key elements in the nurse’s ability to determine what? A) dosage scheduling B) amount of solution for mixing parenteral drugs C) timing of other drugs the client is taking D) how long the client has to take the drug

Ans: A

Feedback: These processes are key elements in determining the amount of drug (dose) and the frequency of dose repetition (scheduling) required to achieve the critical

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concentration for the desired length of time. The processes in dynamic equilibrium are not key elements in determining the amount of diluents for intramuscular (IM) drugs; they do not aid in the timing of the other drugs the client is taking or how long the client has to take the drug.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 22, Pharmacokinetics 15. The nurse is assessing factors that may affect the absorption of a drug that the nurse will soon administer. What factor should the nurse prioritize? A) the client’s blood urea nitrogen and creatinine levels B) the route of administration that has been prescribed C) the client’s liver enzyme levels D) the date on which the client began taking the medication

Ans: B

Feedback: Drug absorption is influenced by the route of administration. IV administration is the fastest method; drug absorption is slower when given orally. Kidney function impacts excretion while liver function impacts metabolism. The length of time the client has been taking the drug has no appreciable effect on absorption.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 22, Pharmacokinetics 16. The nurse has administered a drug that is known to be lipid soluble. This drug’s solubility will primarily affect what aspect of pharmacokinetics? A) absorption of the drug B) metabolism of the drug C) excretion of the drug D) distribution of the drug

Ans: D

Feedback: Factors that can affect distribution include the drug’s lipid solubility and ionization and the perfusion of the reactive tissue. The lipid solubility of a drug does not influence absorption, metabolism, or excretion.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 22, Pharmacokinetics; 27, Box 2.2 17. A nurse has identified the half-life of a drug that will be administered to a client for the first time. The nursing drug guide states that the drug’s half-life is 90 minutes. The nurse should identify what implication of this fact? A) Ninety minutes after drug levels peak, there will be 50% of the peak level. B) In 3 hours, there will be no detectable levels of the drug present in the client’s body. C) Drug levels will rise steadily after administration, reaching 50% of maximum concentration after 90 minutes.

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D) Peak drug levels will be achieved 90 minutes after the drug is administered.

Ans: A

Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to half the peak level it previously achieved. In this case, 50% of peak levels will be achieved 90 minutes after the peak. Two half-life cycles of 90 minutes each (3 hours) would result in a concentration of 25% of the peak (50% of 50%). Format: Fill-in-the-Blank Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 22, Pharmacokinetics; 27, Box 2.2 18. The client is taking a 2-mg dose of ropinirole XR. The drug has a half-life of 12 hours. In how many hours will 0.25 mg of this drug remains in the client’s system?

Ans: 36 hours

Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to half of the peak level it previously achieved. At 12 hours, there will be 1 mg of the drug available to the body. At 24 hours, there will be 0.5 mg; at 36 hours, there will be 0.25 mg; at 48 hours, there will be 0.125 mg; and at 60 hours, there will be 0.0625 mg.

Format: Fill-in-the-Blank Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult

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Integrated Process: Nursing Process Objective: 3 Page and Header: 22, Pharmacokinetics; 27, Box 2.2 19. The client has been diagnosed with multiple sclerosis and is taking the drug interferon beta-1a. The client takes this drug by subcutaneous injection three times a week. The dosage is 44 mcg per injection. If the client takes an injection on Monday, how many micrograms of the drug would still be in the client’s system when they take the next injection on Wednesday, assuming the half-life of the drug is 24 hours?

Ans: 11 mcg

Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to one-half the peak level it previously achieved. On Tuesday, there would be 22 mcg remaining in the body. On Wednesday, 11 mcg would remain. At 12 hours before taking the next dose on Wednesday, there would be 16.5 mcg remaining. If the injection were not taken on Wednesday, 12 hours after the dose was due, there would be 5.5 mcg remaining.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 22, Pharmacokinetics; 27, Box 2.2 20. The client is a 6-year-old child who is taking 125 mg of amoxicillin every 6 hours. Assuming that the half-life of amoxicillin is 3 hours, approximately how much amoxicillin would be in the child’s body at the time of the next administration of the drug? A) 63 mg B) 47 mg C) 31 mg

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D) 16 mg

Ans: C Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to one-half the peak level it previously achieved. There would be 62.5 mg at 3 hours after the original dose of amoxicillin. There would be 46.875 mg present 4½ hours after the original dose. There would be 31.25 mg at 6 hours after the original dose. There would be 15.625 mg at 7½ hours after the original dose.

Format: Fill-in-the-Blank Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 22, Pharmacokinetics; 27, Box 2.2 21. A drug with a half-life of 4 hours is administered at a dosage of 100 mg. How many milligrams of the drug will be in the client’s system 8 hours after administration?

Ans: 25 mg

Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to one-half the peak level it previously achieved. Two half-life cycles would yield a serum concentration of 25% of the peak (50% of 50%) or 25 mg in this case.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 3 Page and Header: 22, Pharmacokinetics; 27, Box 2.2 22. The nurse administers amoxicillin 500 mg. The half-life of this drug is approximately 1 hour. At what point would the drug level in the body be 62.5 mg if the drug was not administered again? A) 1 hour after the original dose B) 2 hours after the original dose C) 3 hours after the original dose D) 4 hours after the original dose

Ans: C

Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to one-half of the peak level it previously achieved. At a dose of 500 mg, the drug level would be 250 mg in 1 hour, 125 mg in 2 hours, 62.5 mg in 3 hours, and 31.25 mg in 4 hours so the correct answer is 3 hours.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 22, Pharmacokinetics 23. The nurse is caring for a client diagnosed with a brain infection of bacterial etiology. When administering medications to this client, the nurse should prioritize what variable related to the client’s diagnosis? A) The client will require lipid-soluble antibiotics. B) The client’s blood–brain barrier will not allow medications to affect brain tissue. C) Antibiotics will have to be injected directly into brain tissue.

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D) Active infection may destroy the integrity of the blood–brain barrier.

Ans: A

Feedback: Effective antibiotic treatment can occur only when the infection is severe enough to alter the blood–brain barrier and allow antibiotics to cross. Lipid-soluble, not water-soluble, medications cross the blood–brain barrier more easily, and most antibiotics are not lipid soluble, so they are not the exception. No matter where the infection originates, drugs must cross the blood–brain barrier to treat central nervous system infections. Infection will not destroy the blood–brain barrier, which blocks drugs selectively.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 22, Pharmacokinetics 24. The client with a history of ischemic heart disease is prescribed aspirin 81 mg daily. The nurse should explain that less than 81 mg actually reaches target tissue due to which action? A) slow distribution B) first-pass effect C) reduced absorption D) adverse effects

Ans: B Feedback: Drugs that are taken orally are usually absorbed from the small intestine directly into the portal venous system. These absorbed molecules are then delivered into the liver, which immediately breaks the drug into metabolites, some of which are active

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and cause effects in the body and some of which are deactivated and can be readily excreted from the body. A large percentage of the oral dose is destroyed at this point and never reaches the tissues. This process is caused by the first-pass effect, not by slow distribution, reduced absorption, or adverse drug effects.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 31, Nursing Care Guide for R.D 25. The nurse is reviewing the results of the client’s laboratory tests. What factor should the nurse most consider when reviewing these results related to medication administration? A) the client’s emotional response to the disease process B) the timing of the last dose of medication relative to when blood was drawn C) the possibility of a drug–laboratory test interaction D) a change in the body’s responses or actions related to the drug

Ans: C

Feedback: The body works through a series of chemical reactions. Because of this, administration of a particular drug may alter results of tests that are done on various chemical levels or reactions as part of a diagnostic study. This drug–laboratory test interaction is caused by the drug being given and not necessarily by a change in the body’s responses or actions. The client’s emotional response or timing of the last dose is not important in drug–laboratory interactions.

Format: Multiple Selection

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Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 31, Nursing Care Guide for R.D. 26. A client has been diagnosed with gonorrhea and been prescribed oral tetracycline. What should the nurse include in health education about tetracycline? Select all that apply. A) Avoid excessive sodium intake for the duration of treatment. B) Do not take the drug with foods or other drugs that contain calcium. C) Do not take the drug at the same time as an iron supplements or high-iron foods. D) Avoid OTC medications that contain aspirin. E) Avoid salt substitutes and foods that are high in potassium.

Ans: B, C

Feedback: The antibiotic tetracycline is not absorbed from the gastrointestinal (GI) tract if calcium or calcium products (e.g., milk) are present in the stomach. It cannot be taken with iron products because a chemical reaction occurs preventing absorption. There is no particular need to avoid sodium, potassium, or aspirin.

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27. A nurse is caring for a client taking multiple drugs and is concerned about a possible drug–drug interaction. How should the nurse best avoid a drug–drug interaction? A) Consult a drug guide prior to drug administration. B) Perform a comprehensive health assessment prior to drug administration. C) Ensure that there is 90 minutes between administration of different drugs. D) Ask for input from a pharmacist or the prescriber.

Ans: A

Feedback: Whenever two or more drugs are being given together, first consult a drug guide for a listing of clinically significant drug–drug interactions. There may be a possibility of changing administration times, but the nurse cannot unilaterally make this decision. Health assessment prior to administration has no direct effect on the likelihood of a drug–drug interaction. It is prudent to collaborate with the prescriber and/or the pharmacist, but this does not negate the need to consult reputable published information.

Format: Multiple Selection Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 31, Nursing Care Guide for R.D. 28. The nurse should promote optimal drug effectiveness by performing what actions? Select all that apply. A) Incorporate basic history and physical assessment factors into the plan of care. B) Evaluate the effectiveness of drugs after they have been administered. C) Modify the drug regimen within the nursing scope of practice to modify adverse or intolerable effects. D) Minimize the number of medications administered to clients.

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E) Examine factors known to influence specific drugs if they are to be effective.

Ans: A, B, C, E

Feedback: Incorporate basic history and physical assessment factors into any plan of care so that obvious problems can be identified and handled promptly. If a drug simply does not do what it is expected to do, further examine the factors that are known to influence drug effects. Frequently, the drug regimen can be modified to deal with that influence. Minimizing the number of medications administered is usually not an option because each drug is ordered for a reason of necessity for the client. Minimizing drugs reduce the risk of adverse effects and drug–drug interactions, but it does not enhance effectiveness of drugs.

Ans: A

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Feedback: If a drug is taken in successive doses at intervals that are shorter than recommended, or if the body is unable to eliminate a drug properly, the drug can accumulate in the body, leading to toxic levels and adverse effects. This is a cumulative effect. Drug–drug interactions are always a risk, but this risk is not increased by impaired renal function. Renal function has no effect on absorption, and it does not increase tolerance.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 28, Factors Influencing Drug Effects 30. The client diagnosed with terminal cancer pain has been receiving morphine sulfate for several days. For the past few days, the medication is no longer effective in controlling the client’s pain, and a larger dose is needed to have the same effect. How should the nurse explain this phenomenon to the client? A) “This is likely a result of your developing tolerance to the medication.” B) “There is likely a build-up of morphine in your body that is unable to affect your pain receptors.” C) “I’ll collaborate with your provider to see if there might be other medications that are counteracting your morphine.” D) “You might be developing a mild addiction to morphine, but this is certainly treatable.”

Ans: A

Feedback: The body may develop a tolerance to some drugs over time. Tolerance may arise because of increased biotransformation of the drug, increased resistance to its effects, or other pharmacokinetic factors. When tolerance occurs, the amount of the drug

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no longer causes the same reaction. Therefore, increasingly larger doses are needed to achieve a therapeutic effect. This is not synonymous with addiction, which is psychological dependence. The client’s need for higher doses does not suggest drug accumulation.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 28, Factors Influencing Drug Effects 31. The client expresses relief to the nurse after being prescribed a new medication, stating that they expect to experience great benefits. The nurse suspects this drug will be more effective than usual for this client because of what effect? A) cumulative effect B) first-pass effect C) placebo effect D) cross-tolerance effect

Ans: C

Feedback: A drug is more likely to be effective if the client thinks it will work than if the client believes it will not work. This is called the placebo effect. If a drug is taken in successive doses at intervals that are shorter than recommended, or if the body is unable to eliminate a drug properly, the drug can accumulate in the body, leading to toxic levels and adverse effects. This is a cumulative effect. First-pass effect addresses the reduction of available drug when taken orally due to metabolism in the liver before the drug reaches the bloodstream. Cross-tolerance is resistance to drugs within the same class.

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Format: Multiple Selection Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 22, Pharmacokinetics 32. The nurse administers an intravenous medication with a half-life of 24 hours. The nurse should recognize what factors in this client that could extend the drug’s half-life? Select all that apply. A) gastrointestinal disease B) kidney disease C) liver disease D) cardiovascular disease E) route of administration

Ans: B, C, D Feedback: Kidney disease could slow excretion and extend the drug’s half-life. Liver disease could slow metabolism resulting in an extended half-life. Cardiovascular disease could slow distribution resulting in a longer half-life. Gastrointestinal disease would not impact half-life because the medication was injected directly into the bloodstream. Route of administration would not extend half-life because IV injection eliminates the absorption step in the process.

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Page and Header: 28, Factors Influencing Drug Effects 33. What information should the nurse provide a client who has developed antibodies to a newly prescribed biological medication? A) “The antibodies will prevent you from becoming allergic to the drug.” B) “You are now allergic to the proteins in the drug itself.” C) “These antibodies will make the medication extremely effective.” D) “You may experience an allergic reaction to this medication if you receive it again.”

Ans: D

Feedback: People can develop allergies to drugs. After exposure to a drug’s proteins, a person can develop antibodies to that drug. The client is not allergic to the medication’s proteins currently, but with future exposure to the drug, that person may experience a full-blown allergic reaction. Biological medications may lose efficacy in clients who have developed antibodies to those medications. This is most common with biologic medications.

Test Generator Questions, Chapter 3, Toxic Effects of Drugs Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 36, Adverse Effects; 37, Box 3.1 1. A nurse is planning client teaching about a newly prescribed drug. What teaching point should the nurse provide to best improve adherence and safety? A) list of pharmacies where the drug can be obtained B) measures to alleviate any discomfort associated with adverse effects C) the benefits of the prescribed drug over alternatives from the same class D) statistics related to phase III testing for the prescribed drug

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Ans: B

Feedback: If a client is aware of certain adverse effects and how to alleviate or decrease the discomfort, they are more likely to continue taking the medication. A list of pharmacies can be useful information but will not improve safety or compliance. Knowing the relative benefits of the drug over alternatives may enhance adherence but has no effect on safety. Most clients are not concerned with the statistics related to drug testing, and it would not improve adherence or safety even if the client was interested in the information.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 38, Drug-Induced Tissue and Organ Damage 2. A client presents at the clinic reporting vaginal itching and a clear discharge. The client reports to the nurse that they have been taking an oral antibiotic for 10 days. What is the nurse’s best action? A) Assess for further signs of an adverse reaction to the antibiotic. B) Advocate for discontinuation of the drug due to the presence of toxic effects. C) Educate the client about the fact that an overdose may be damaging more than one body system. D) Educate the client about the likelihood of a superinfection caused by destruction of normal flora.

Ans: D

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Feedback: Superinfections often occur with antibiotic use because the drug kills normal bacterial flora. This is not a result of toxic levels of the antibiotic, but rather an effect of the medication that has killed normal flora, which it is designed to do. Vaginal itching and a clear discharge are not considered adverse effects of an antibiotic. An overdose of a drug that damages more than one body systems is considered drug poisoning.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 36, Adverse Effects 3. A client experiencing seasonal allergies is taking an over-the-counter (OTC) antihistamine to relieve itchy, watery eyes, and a runny nose. When planning teaching for this client, the nurse would include what teaching point? A) Limit fluid intake to dry out mucous membranes. B) Avoid driving or operating machinery. C) There’s a possibility of insomnia. D) Grapefruit juice should be avoided during treatment.

Ans: B

Feedback: An adverse effect of antihistamines is drowsiness, so that injury to the client or others can occur if driving or operating machinery. An increase in fluids would be indicated to help keep nasal membranes moist. Drowsiness is more likely than insomnia. Grapefruit juice does not interfere with the metabolism of antihistamines.

Format: Multiple Choice Chapter: 3

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 40, Toxicity 4. A nurse is providing teaching to a group of clients who are beginning drug therapy for human immunodeficiency syndrome (HIV). What should the nurse teach the group? A) “Make sure not to take more than prescribed, because poisoning can cause damage to more than one body system.” B) “Damage to your kidneys can result when the drug is excreted from the system by what’s called the ‘first-pass effect’.” C) “A blood dyscrasia due to drug therapy can be serious. Call us if your skin looks yellowish or you experience itching.” D) “Most drugs are processed in the liver, and the first indication of damage is dark red bumps on your skin, which should be reported immediately.”

Ans: A

Feedback: Poisoning resulting from overdosage can lead to the potential for fatal reactions when more than one body system is affected. Liver, not kidney, injury can be caused by the first-pass effect and can cause the skin to have a yellow appearance. Most drugs are metabolized in the liver, but liver damage causes jaundice, manifested as a yellow tinge to the skin and sclera. Dark red papules appearing on limbs are characteristic of Stevens–Johnson syndrome, a potentially fatal erythema multiforme exudativum, which should be reported but is not due to liver damage.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult

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Integrated Process: Nursing Process Objective: 3 Page and Header: 41, Electrolyte Imbalances 5. The nurse is caring for a client who has been taking potassium-sparing diuretic. What assessment finding would suggest an adverse reaction? A) urine output of 1,500 mL/24 hours B) blood pressure of 98/60 mm Hg C) heart rate of 47 beats/min D) calcium level of 10.6 mg/dL (2.5 mmol/L)

Ans: C

Feedback: Potassium-sparing diuretics carry a risk of hyperkalemia. The normal range of serum potassium for an adult is 3.5 to 5.0 mEq/L. A level higher than 5.0 mEq/L can indicate hyperkalemia, which can result in bradycardia. Normal urinary output is between 1,500 and 2,000 cc/d. Urinary output below 1,000/d would include oliguria and would indicate hyperkalemia. A decrease in blood pressure and pulse can indicate hypokalemia. Calcium levels would not normally be affected.

Format: Multiple Choice. Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 3 Page and Header: 42, Sensory Effects 6. An older adult who has been taking a macrolide antibiotic has developed auditory nerve damage. What instructions should the nurse provide for the family regarding home care? A) Keep the client in a prone position when in bed. B) Minimize the client’s sodium intake.

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C) Provide protective measures to prevent falling or injury. D) Limit the client’s exposure to sunlight.

Ans: C

Feedback: Macrolide antibiotics can cause severe auditory nerve damage, which can cause dizziness, ringing in the ears (tinnitus), and loss of balance and hearing. The client would be at high risk for injury due to falls. Usually a person who is dizzy is unable to lie flat and needs to recline with the head elevated. Sodium and sunlight limitations are not components of this client’s health needs.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 41, Alterations in Glucose Metabolism 7. The nurse is providing care for a client diagnosed with type 2 diabetes who is being treated with glipizide. The nurse recognizes it is important to monitor the client for which potential adverse effects? A) increased urine output B) deep Kussmaul respirations C) thirst and hot, flushed skin D) confusion and lack of coordination

Ans: D

Feedback: Antidiabetic medications decrease blood glucose levels. If levels fall too low, symptoms of hypoglycemia would include confusion and lack of coordination. Elevated blood glucose levels can occur when the client does not take the medications. With

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inadequate dosage, hyperglycemia can occur, resulting in increased urination in an attempt to eliminate serum glucose, deep Kussmaul respirations to reduce blood pH by eliminating carbon dioxide, thirst, and hot, flushed skin.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 42, Sensory Effects 8. A client is prescribed chloroquine for rheumatoid arthritis. What report by the client should the nurse interpret as a possible adverse reaction to the medication? A) “I have to urinate all the time.” B) “Sometimes I have blurred vision.” C) “I have tingling in my arms and legs.” D) “Sometimes I feel like I am off balance.”

Ans: B

Feedback: Chloroquine can cause ocular toxicity with blurring of vision, color vision changes, corneal damage, and blindness. Increased urination, tingling, and numbness are signs of hyperkalemia and hypokalemia. Loss of balance can be caused by auditory damage due to drug toxicity.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 5 Page and Header: 42, Neurological Effects 9. A client who regularly takes antihistamines for severe allergies is planning a tropical vacation. What health education related to drug therapy should the nurse provide? A) “Avoid sightseeing during the hottest part of the day.” B) “Discontinue the antihistamines if you feel restless.” C) “Decrease the dosage if you experience excessive thirst.” D) “Be very sure to wear a high-SPF sunscreen at all times.”

Ans: A

Feedback: Antihistamines can cause anticholinergic effects, which would result in decreased sweating and place the client at high risk for heat stroke. Avoiding the hottest part of the day will help prevent dehydration and heat prostration. Extreme restlessness could indicate Parkinson-like syndrome not usually associated with antihistamines. Excessive thirst is characteristic of hyperglycemia. Nurses should never tell clients to decrease or discontinue a drug unless the prescriber has instructed them to do so. Sun protection is necessary for all clients, but this is unrelated to antihistamine use.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 36, Adverse Effects 10. The caregiver of an older adult client diagnosed with ischemic heart disease tells the nurse that the client is only taking around half of the prescribed dosage of several medications. What possible effect should the nurse explain when providing health education?

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A) increased risk of primary actions B) antibiotic resistance C) superinfection D) adverse effects

Ans: D

Feedback: Taking too little of the medication would mean that therapeutic levels are not being reached and the drugs will be less effective at lower dosages or even lead to adverse effects. Primary actions are the result of overdose, which is not the case in this client who is taking too little of the drug. Superinfection and eventual antibiotic resistance would only result if the client was taking an antibiotic, which is not indicated by the question.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 36, Adverse Effects; 37, Box 3.1 11. A client with Parkinson’s disease has been prescribed an anticholinergic medication. The client reports having difficulty voiding. How should the nurse interpret this finding? A) hypersensitivity to the drug B) the primary action of the drug C) an allergic action to the drug D) a secondary action of the drug

Ans: D Feedback: Sometimes the drug dosage can be adjusted so that the desired effect is achieved without producing undesired secondary reactions. But sometimes, this is not

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possible, and the adverse effects are almost inevitable. In such cases, the client needs to be informed that these effects may occur and counseled about ways to cope with the undesired effects. The situation described is not a hypersensitivity reaction that would indicate an allergic reaction, a primary reaction that would be excessive therapeutic response, or an allergic reaction to the drug.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 36, Adverse Effects; 37, Box 3.1 12. The nurse is assessing a client new to the clinic. The client says they are allergic to penicillin. What action should the nurse take next? A) Assess the exact nature of the client’s response to the drug. B) Document that the client is allergic to penicillin. C) Perform a comprehensive health assessment. D) Continue to assess the client for other allergies.

Ans: A

Feedback: The nurse should ask additional questions to clients who state that they have a drug “allergy” to ascertain the exact nature of the response and whether it is a true drug allergy. Clients may confuse secondary actions of the drug with an allergy. The nurse is obliged to document the client’s statement and should assess the client, but the nurse should first gather more data about the nature of the client’s responses to penicillin. Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 40, Toxicity 13. The nurse is assessing a client whose asthma is being treated with prednisone. What assessment finding should the nurse attribute to a possible adverse reaction? A) The client has an audible wheeze on expiration. B) The client’s blood glucose levels are 200 mg/dL (11.1 mmol/L). C) The client feels cold despite the room being warm. D) The client has not had a bowel movement for 3 days.

Ans: B

Feedback: Prednisone, a drug used as a corticosteroid that can be used to decrease inflammatory effects, can break down stored glycogen and cause an elevation of blood glucose by its effects on the sympathetic nervous system. Ephedrine does not cause bronchoconstriction, cold intolerance, or constipation.

Format: Multiple Selection Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Easy Integrated Process: Caring Objective: 3 Page and Header: 43, Teratogenicity 14. The nurse should consider teratogenic effects when caring for what clients? Select all that apply. A) an 81-year-old male with chronic heart failure and peripheral edema B) a 41-year-old male who is immunocompromised following bone marrow transplant

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C) a 44-year-old female being treated in the intensive care unit for multiorgan dysfunction syndrome D) a 29-year-old client receiving prenatal care in her first trimester of pregnancy E) a 37-year-old female client who is taking fertility drugs

Ans: D, E

Feedback: A teratogen is a drug that can harm the fetus or embryo so the nurse would consider the teratogenic properties of medications when caring for clients of childbearing age including adolescents and young adult women. Teratogens have no impact on clients who are not pregnant and who may not become pregnant.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 38, Drug-Induced Tissue and Organ Damage 15. The nurse is caring for a client receiving an antineoplastic medication who reports fever, chills, sore throat, weakness, and back pain. The nurse should recognize the possibility of what adverse effect? A) dermatologic reaction B) blood dyscrasia C) electrolyte imbalance D) superinfection

Ans: B

Feedback: Symptoms of blood dyscrasias include fever, chills, sore throat, weakness, back pain, dark urine, decreased hematocrit (anemia), low platelet count

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(thrombocytopenia), low white blood cell count (leukopenia), and a reduction of all cellular elements of the complete blood count (pancytopenia). Dermatologic reactions would be reflected in skin alterations, electrolyte imbalances would result in differing symptoms depending on the electrolyte involved but would not cause chills and fever, and a superinfection could cause a fever but would not cause a sore throat, weakness, or back pain unless the infection involved those body parts.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 31 Page and Header: 36, Adverse Effects 16. The nurse is caring for a client who is exhibiting adverse medication effects. The nurse should recognize that adverse effects can be extensions of what? A) the primary action of a drug B) anaphylaxis C) the secondary action of a drug D) an anticholinergic response to the drug

Ans: A

Feedback: Primary action adverse effects are extensions of the therapeutic action and are usually the result of overdosage, essentially too much of the therapeutic effect. Anaphylaxis is not an extension of the therapeutic action of the drug but a histamine reaction to an allergen. Secondary actions of a drug are negative effects of the drug that occur even when the drug is in the therapeutic range. Anticholinergic responses occur in response to drugs that block the parasympathetic nervous system.

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Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 32 Page and Header: 36, Adverse Effects; 37, Box 3.1 17. A student nurse asks the study group how to define a drug allergy. What would be the peer group’s best response? A) a second effect of the body to a specific drug B) the formation of antibodies to a drug protein causing an immune response when the person is next exposed to that drug C) a serum sickness caused by a reaction to a drug D) immediate systemic reaction to the drug when exposed to the drug the first time

Ans: B

Feedback: A drug allergy occurs when the body forms antibodies to a particular drug, causing an immune response when the person is re-exposed to the drug. A drug allergy does not occur at the first exposure to a drug. A second action of a specific drug is an adverse response that the drug causes in addition to the therapeutic effect. Serum sickness is one type of allergic reaction but does not define allergic reaction. An immediate systemic reaction to a drug, usually not on first exposure, is an anaphylactic reaction.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning

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Objective: 5 Page and Header: 36, Adverse Effects; 37, Box 3.1 18. The home health nurse is caring for an older adult client diagnosed with benign prostatic hypertrophy (BPH). An anticholinergic drug has been prescribed for an unrelated health problem. What health education should the nurse provide to this client? A) “Many clients develop temporary urinary incontinence.” B) “There’s a possibility that you might experience some bladder pain.” C) “The fact that you have BPH might mean you need a higher dose than usual.” D) “It’s best if you can empty your bladder before taking the drug.”

Ans: D

Feedback: A client with an enlarged prostate who takes an anticholinergic drug may develop urinary retention or even bladder paralysis when the drug’s effects block the urinary sphincters, so anticholinergic drugs are avoided whenever possible. However, if the medication is needed, the client must be taught to empty the bladder before taking the drug. A reduced dosage also may be required to avoid potentially serious effects on the urinary system, but this would not be a teaching point for the client because the provider will make that decision. Urinary incontinence is not a likely adverse effect in this case. There is no increased risk of bladder pain. Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 5 Page and Header: 36, Adverse Effects; 37, Box 3.1 19. The Kardex of a client who is prescribed antihistamines for treating an allergy reads as follows: “Age: 32; Profession: Long-distance truck driver; Lifestyle and diet: Lives alone, chews tobacco, no alcohol use, no food preferences, practices martial arts; Medical history:

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Suffers from seasonal allergies, recent urinary tract infection that has been treated successfully.” What information from the Kardex is likely to have the greatest implication in educating the client about antihistamine administration? A) the client’s age B) the client’s smoking habit C) the client’s profession D) the client’s medical history

Ans: C

Feedback: Most antihistamines cause drowsiness, so the nurse should advise the client not to operate machinery or perform tasks that require alertness when taking antihistamines. Because the client is not an older adult, their age has no implications on the therapy. Although encouraging the client to make better lifestyle choices is an important part of the client’s plan of care, this information is not related to administration of antihistamines. There is nothing in the documented medical history that is significant to antihistamine use.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 4 Page and Header: 40, Toxicity 20. The nurse is caring for a client who experienced a severe headache. When the prescribed dose of analgesics did not cause relief, the client took double the dosage 1 hour later. The nurse should assess the client for what adverse effect? A) an allergic reaction B) anaphylactic reaction

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C) poisoning D) sedative effects

Ans: C

Feedback: This client has taken an overdosage of the medication. Poisoning occurs when an overdose of a drug damages multiple body systems, leading to the potential for fatal reactions. Allergic and anaphylactic reactions can occur with any drug administration, but this is not the client’s greatest risk. More information about the exact type of medication would be needed to determine whether sedative effects are likely.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 36, Adverse Effects; 37, Box 3.1 21. Why does the nurse need to be alert for any indication of an allergic reaction in clients? A) to obtain early warning of noncompliance in drug therapy B) to increase the effectiveness of a specific medication C) to maintain the client’s safety during drug therapy D) to reduce the risk of adverse effects during drug therapy

Ans: C

Feedback: Being alert to adverse effects—what to assess and how to intervene appropriately—can increase the effectiveness of a drug regimen, provide for client safety, and improve client compliance. Indications of allergic reactions would not indicate

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noncompliance or improve effectiveness of a specific medication. Indications of allergic reaction would indicate an adverse effect and would not reduce the risk.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 36, Adverse Effects; 37, Box 3.1 22. The nurse administers doxycycline, a drug known to cause gastritis. When the client reports abdominal discomfort after taking the medication, the nurse should classify this discomfort as what type of adverse effect? A) primary action B) secondary action C) hypersensitivity reaction D) allergic reaction

Ans: B

Feedback: Secondary actions are those actions that occur as a result of taking a medication but do not fall under the category of therapeutic action and are often negative. This client is experiencing a secondary action of erythromycin. Primary actions would be extensions of therapeutic action. Hypersensitivity reaction would be an excessive response to either the primary or secondary effects of a drug. An allergic reaction would be an immune response to the drug.

Format: Multiple Selection Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 36, Adverse Effects 23. The nurse administers typical antipsychotic medications to the client who has taken these same drugs for many years. What signs and symptoms should the nurse attribute to secondary actions of the drug? Select all that apply. A) muscular tremors B) drooling C) changes in gait D) yellow discoloration of the skin and sclera E) fine red rash on the trunk

Ans: A, B, C

Feedback: Drugs that affect the dopamine levels in the brain (e.g., typical antipsychotic drugs) cause a syndrome that resembles Parkinson’s disease including lack of activity, akinesia, muscular tremors, drooling, changes in gait, rigidity, extreme restlessness or “jitters” (akathisia), or spasms (dyskinesia). Yellow discoloration of the skin and sclera indicate jaundice and would suggest liver damage. A fine red rash on the trunk would be a dermatologic reaction unrelated to an antipsychotic agent’s secondary effects.

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24. The triage nurse in the emergency department admits a 16-year-old client brought in by ambulance and accompanied by a friend. The client is in respiratory distress, is vomiting, and blood is noted in the vomitus. The client is somnolent, and the electrocardiogram demonstrates an arrhythmia. The friend admits that the client took “a bunch of little green pills” from the cupboard at the grandparents’ house. The nurse should recognize the likelihood of what adverse reaction? A) serum sickness B) poisoning C) anaphylaxis D) delayed hypersensitivity

Ans: B

Feedback: Poisoning occurs when an overdose of a drug damages multiple body systems, leading to the potential for fatal reactions. The symptoms do not indicate an anaphylactic reaction, which would not normally include bloody vomitus. Serum sickness and delayed hypersensitivity do not cause this particular presentation.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 41, Alterations in Glucose Metabolism 25. A client diagnosed with diabetes is also taking prednisone to treat asthma. On occasion, the client notes that the drug causes an increase in blood glucose. What should the nurse teach the client about this phenomenon? A) “The active ingredient in ephedrine is mixed with glucose.” B) “Ephedrine causes existing glucose to stay in circulation longer.” C) “Stored glycogen is broken down by corticosteroids, causing hyperglycemia.”

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D) “Insulin is partially inactivated by ephedrine so it cannot work to control sugar levels.”

Ans: C

Feedback: Prednisone breaks down stored glycogen, which then enters the bloodstream as glucose and causes an increase in serum blood glucose, or blood sugar, levels. Ephedrine is not mixed with sugar, and it does not cause glucose to stay in circulation longer. Ephedrine has no effect on insulin.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 42, Neurological Effects 26. The nurse is writing a plan of care for a client who is exhibiting Parkinson-like syndrome. The nurse observes that the client is having occasional difficulty swallowing. In addition to close monitoring, what is the nurse’s most appropriate action? A) Advocate for the insertion of a feeding tube. B) Keep the client NPO (not taking anything orally). C) Give only soft or pureed foods. D) Provide small, frequent meals.

Ans: D

Feedback: Provide small, frequent meals if swallowing becomes difficult. Keeping the client NPO would be inappropriate because these effects often result from medications that will be taken throughout the client’s life. Soft or pureed foods are often more difficult to swallow than more rigid foods. Thickening liquids would only be necessary if

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the dysphagia, or difficulty swallowing, continued to progress. Tube feeding would be an action of last resort.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 41, Electrolyte Imbalances 27. A client is admitted to the intensive care unit experiencing hyperkalemia due to the use of potassium-sparing diuretics. What assessment should the nurse prioritize? A) orientation to name, place, and time B) cardiac monitoring C) urine output D) temperature

Ans: B

Feedback: Monitor for cardiac irregularities because potassium is an important electrolyte in the action potential, needed for cell membrane stability. When potassium levels are too high, the cells of the heart become very irritable and rhythm disturbances can occur. Be prepared for a possible cardiac emergency; cardiac monitoring is prioritized over cognition, urine output, and temperature, though all of these would be included in assessments.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 42, Sensory Effects 28. Before administering a macrolide antibiotic, the nurse should question the order for what client? A) an 82-year-old woman with hypertension B) a 12-year-old boy with hearing loss C) a 30-year-old woman with irritable bowel syndrome D) a 51-year-old man after myocardial infarction Ans: B

Feedback: Macrolide antibiotics can cause severe auditory nerve damage so the nurse would question administration of this drug to the child with hearing loss because another antibiotic may be indicated to preserve remaining hearing. This drug is not contraindicated in older adults, although a lower dosage may be indicated. It may safely be given in clients with irritable bowel syndrome and after myocardial infarction.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 41, Electrolyte Imbalances 29. A client’s most recent laboratory result indicates an elevated potassium level. What drug in this client’s medication regimen should the care team consider discontinuing? A) a diuretic B) a narcotic C) an antipsychotic D) an antianxiety agent

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Ans: A

Feedback: Elevated potassium levels can result from the use of certain diuretics. Narcotics, antipsychotics, and antianxiety drugs are not associated with this adverse effect.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 41, Electrolyte Imbalances 30. The nurse administers a loop diuretic to the client. In addition to sodium and water, what other electrolyte would the nurse expect to be excreted in significant amounts? A) calcium B) magnesium C) potassium D) zinc

Ans: C

Feedback: Loop diuretics increase excretion of sodium, water, and potassium most significantly. Although other electrolytes may be excreted, loss of magnesium, calcium, and zinc are usually not significant.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand

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Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 42, Neurological Effects 31. The nurse administers a medication to the client that induces the secondary action of hypoglycemia. What organ will be most acutely impacted by inadequate circulating glucose? A) brain B) heart C) lungs D) skin

Ans: A

Feedback: While all cells require glucose to function, the brain uses the greatest amount. As a result, hypoglycemia has the greatest impact on the brain, which explains why hypoglycemia has so many neurological signs and symptoms including fatigue; drowsiness; hunger; anxiety; headache; cold, clammy skin; shaking and lack of coordination (tremulousness); increased heart rate; increased blood pressure; numbness and tingling of the mouth, tongue, and/or lips; confusion; and rapid and shallow respirations. In severe cases, seizures and/or coma may occur because the brain cannot function without adequate supplies of glucose.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understanding Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 38, Drug-Induced Tissue and Organ Damage

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32. A client being treated with trimethoprim has developed a painless rash on their arms that is characterized by dark red papules. The client must be assessed by the nurse for additional symptoms of which potentially fatal reaction? A) Stevens–Johnson syndrome B) type I immediate hypersensitivity disorder C) serum sickness D) neuroleptic malignant syndrome

Ans: A

Feedback: Many drugs are known to cause skin reactions. Sulfamethoxazole and trimethoprim, a drug used to treat urinary tract infections and other infections caused by susceptible pathogens, can cause an itchy, red rash and in some clients has caused a serious and potentially fatal skin reaction, Stevens–Johnson syndrome. A type I immediate hypersensitivity disorder involves an antibody (IgE) that reacts with type 2 helper T cell that leads to plasma cell production of IgE and mast cell sensitization, which will cause the release of inflammatory chemicals. Serum sickness is an immune complex–mediated hypersensitivity reaction that classically presents with fever, rash, polyarthritis, or polyarthralgias. General anesthetics and other drugs that have direct CNS effects can cause neuroleptic malignant syndrome (NMS), a generalized syndrome that includes high fever; if not treated quickly, NMS can be fatal.

Format: Multiple Selection Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 38, Drug-Induced Tissue and Organ Damage

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33. A client is prescribed a nonsteroidal anti-inflammatory drug (NSAID). What information should the nurse include when providing medication education to this client? Select all that apply. A) The medication can cause heartburn. B) Constipation is commonly reported. C) Vomiting is a common side effect. D) Medication should be taken with food. E) Motility stimulants are often prescribed.

Ans: A, C, D

Feedback: Nonsteroidal anti-inflammatory drugs (NSAIDs) can decrease the mucosal membrane in the GI tract and increase risk of mucosal damage with symptoms that include heartburn and vomiting. Some GI irritation may be decreased if the medication is taken with food. Opioid medications are known to slow peristalsis and increase the risk of constipation. The constipation caused by medications can be prevented with motility stimulants.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 38, Drug-Induced Tissue and Organ Damage 34. Which client is at greatest risk for the development of medication-induced oral stomatitis? A) a 45-year-old client being treated for cancer of the tongue B) a 78-year-old client prescribed cholinesterase inhibitor for dementia C) a 16-year-old client being treated with an antidepressant for anorexia D) a 9-year-old client receiving an opioid post abdominal surgery

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Ans: A

Feedback: Stomatitis, or inflammation of the mucous membranes, can occur because of a direct toxic reaction to the drug or because the drug deposits in the end capillaries in the mucous membranes, leading to inflammation. Many drugs are known to cause stomatitis. Antineoplastic drugs commonly cause these problems because they are toxic to rapidly turning-over cells such as those found in the GI tract. None of the other options are known to be a risk for stomatitis.

Test Generator Questions, Chapter 4, The Nursing Process in Drug Therapy and Patient Safety Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 48, The Nursing Process; 48, Box 4.1 1. An older adult client who lives independently has just been prescribed a drug that can cause sedation. What would be the priority nursing diagnosis for this client? A) risk for vascular trauma B) wandering C) risk for injury D) risk for suffocation

Ans: C

Feedback: Because of the client’s age and that the medication causes sedation, the highest priority nursing diagnosis is related to maintaining the client’s safety. Sedation often constitutes a falls risk, and safety for the client is the nurse’s number one concern.

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There is no likely risk of vascular trauma, and sedation is unlikely to cause suffocation. Sedation makes wandering less likely not more likely.

Format: Multiple Selection Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 48, Nursing: Art and Science 2. The nurse is preparing to administer scheduled medications to a client in the community. What are responsibilities of the nurse related to the client’s drug therapy? Select all that apply. A) teaching the client how to participate in therapy to ensure best outcomes B) providing therapeutic interventions that complement the medications C) evaluating the effectiveness of the client’s drug therapy D) altering the drug regimen to optimize the client’s outcomes E) recommending appropriate over-the-counter medications as alternatives to prescription drug therapy

Ans: A, B, C

Feedback: A nurse is, therefore, a key health care provider who is in a position to assess the whole client, to administer therapy as well as medications, to teach the client how best to cope with the therapy to ensure the most favorable outcome, and to evaluate the effectiveness of the therapy. Nurses do not alter drug therapy or recommend over-the-counter medications as direct alternatives to prescribed medications.

Format: Multiple Choice

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Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 48, The Nursing Process; 48, Box 4.1 3. The nurse is gathering assessment data from a client who is the sole caregiver for four children. What assessment information should the nurse prioritize when providing care for this client? A) the children’s history of recreational drug use B) the name and location of the client’s preferred pharmacy C) the client’s level of social and financial support D) the last time the client was hospitalized

Ans: C

Feedback: In this situation, insurance, financial support, and stability would be the most important data and may determine adherence to future drug therapy. This is a priority over a history of recreational drug use among the children. The last time the client was hospitalized could indicate whether the client seeks medical care when appropriate or if they self-medicate, contributing to the nurse’s knowledge of this individual, but this is not the priority concern. The name of the pharmacy would be unnecessary unless the nurse anticipates having to call a prescription into the pharmacy for the prescriber.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process

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Objective: 2 Page and Header: 48, Nursing: Art and Science 4. The nurse administered a scheduled dose of hydrochlorothiazide, a diuretic, 45 minutes ago. The nurse is now preparing to assess the client’s blood pressure. In what phase of the nursing process should the nurse perform this action? A) assessment B) nursing diagnosis C) interventions D) evaluation

Ans: D

Feedback: Evaluation allows the nurse to review what has changed since intervening to determine whether the nursing care has had a positive therapeutic effect moving the client toward a more healthful life. If outcomes have not improved, the nurse begins again at the assessment phase of the nursing process with the goal of changing the plan of care to improve outcomes. The client’s response to the drug and occurrence of adverse drug effects indicate the effectiveness of the nursing interventions related to drug therapy. Assessment involves a systematic, organized collection of data concerning a client. A nursing diagnosis indicates actual or potential alterations in client function based on the assessment of the clinical situation. Interventions are actions taken to meet the client’s needs, such as administration of drugs.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 48, Nursing: Art and Science

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5. Before administering a new medication, the nurse has consulted a drug guide to confirm the recommended dosage range. When interpreting this information, the nurse should consider what principle? A) Recommendations are based on clients of Caucasian ethnicity. B) Recommendations are made by the manufacturer based on the most likely recipient population. C) Recommendations are based on 150-pound (68-kg) adult male. D) Recommendations are based on a young adult male with good health.

Ans: C

Feedback: Drug studies base the therapeutic dosage, or that dose needed to reach a critical concentration, on the physiology of a 150-pound (68-kg) healthy adult male. Testing is not routinely done in women because of the potential for unknown effects on the ova. Recommendations are not racially or ethically specific.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 6 Page and Header: 52, Medication Errors 6. The nurse is evaluating the discharge teaching provided to a client concerning drug therapy. What statement from the client would indicate that teaching had been effective? A) “I have to take three pills each day and I can take them at the time that fits my schedule.” B) “I should take the white pill because the doctor wants me to take it.” C) “I’ll add the names and dosages of these new drugs to my medication list in my wallet.”

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D) “I have prescriptions at different pharmacies. I shop around for the best price for each drug.”

Ans: C

Feedback: The client needs to recognize the importance of keeping an updated list of all current medications and the need to share this list with all health care providers to avoid drug–drug interactions. The client should understand exactly when to take medications, why that medication is being taken, and how to take it safely. Clients should be encouraged to use a single pharmacy because this will add another layer of safety because the pharmacy will know all drugs being prescribed to this client.

Format: Multiple Selection Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 48, Nursing: Art and Science 7. The nurse has consulted a drug guide to confirm the recommended dose range of a drug. The nurse should expect to see an adjusted dosage for which clients? Select all that apply. A) a 22-year-old female B) a 39-year-old male C) a 6-month-old infant D) a 2-day-old neonate E) a 79-year-old male

Ans: C, D, E

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Feedback: Clients at the extremes of the age spectrum—children and older adults— often require dosage adjustments based on the functional level of the liver and kidneys and the responsiveness of other organs. The child’s age and developmental level will also alert the nurse to possible problems with drug delivery, such as an inability to swallow pills or follow directions related to other delivery methods. The adult, whether male or female, would not require altered dosage unless a secondary condition such as renal or hepatic alterations existed.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 48, Nursing: Art and Science 8. The nurse is taking a medication history on a client. What action by the nurse best reduces the possibility of adverse interactions? A) Assess the client’s ability to pay for medications. B) Ask the client about the use of any complementary or alternative therapies. C) Assess the client’s nutritional status and preferred diet. D) Perform a head-to-toe physical assessment.

Ans: B

Feedback: Alternative therapies often involve the use of herbal products, which contain natural chemicals that affect the body. Many drug–alternative therapy interactions have been reported that could cause serious adverse effects, but clients often don’t think to mention these therapies when asked about the medications they are taking. The nurse should assess the client’s ability to pay, nutritional status, and overall state of health, but these actions do not directly address the potential for unsafe interactions.

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Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 4 Page and Header: 48, Nursing: Art and Science 9. The nurse is reviewing the client’s medication orders and finds an order stating “amoxicillin 250 mg every 8 hours.” What is the nurse’s best action? A) Confirm the client’s allergy status. B) Ask the prescriber to confirm the route. C) Assess the client for signs of infection. D) Confirm with the prescriber whether a generic version is mandatory.

Ans: B

Feedback: For the nurse to administer a medication, all essential components of a medication order must be written by the prescriber including drug name, dosage, route, frequency, and client name. This order is missing the route, and the drug could be given IV, IM, or PO. The nurse should call the ordering health care provider and clarify what route the medication is to be administered. This must be known before the other listed nursing actions are performed.

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10. The nurse has weighed a new client during the admission assessment. How does this action best contribute to safe medication administration? A) It allows the care team to prescribe the correct medication dosage. B) It provides a baseline for any change in fluid balance. C) It identifies nutritional deficiencies that may affect the drug regimen. D) It confirms whether subcutaneous or intramuscular injections are more appropriate.

Ans: A

Feedback: Dosage of medication is often calculated based on the client’s weight, so getting clients’ weight wrong could cause a medication error. The client’s weight gives information into fluid balance and nutritional status, but these considerations are less important than correct dosing. These data do not inform the prescriber’s decisions around different forms of parenteral administration.

Format: Multiple Selection Chapter: 4 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 6 Page and Header: 52, Medication Errors 11. A nurse is providing health education to a client in the community in an effort to prevent administration errors or adverse effects. What teaching points should the nurse provide? Select all that apply. A) “Feel free to ask questions if there’s anything that’s not clear to you.” B) “Unless you’re told otherwise, store your medications in a warm humid place.” C) “Keep any adjustments to your medication doses to a minimum, even if you’re not feeling well.” D) “Keep an updated list of your prescribed medications with you.” E) “Take all of your medications within 5 minutes of the time you’re instructed.”

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Ans: A, D

Feedback: Appropriate client teaching will reduce the risk of medication errors and complications. Nurses teach clients to speak up, ask questions, and act as their own advocate when medications are being prescribed. The client should keep a complete list of medications and have a copy available at all times in case of accident. Nurses teach clients to store drugs in a dry, cool place away from children and pets that could be harmed. Nurses teach clients to take medications as they have been prescribed and do not adjust dosage without authorization from the prescriber. Nurses teach clients to take medications at the time they are prescribed to be taken; however, there is nearly always more than 5 minutes’ flexibility, especially in a community-dwelling client.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 48, Nursing: Art and Science 12. The nurse is conducting the evaluation phase of the nursing process. The nurse should perform evaluation primarily based on what data? A) the absence of adverse medication effects B) the client’s adherence to the drug regimen C) the client’s knowledge of the drug regimen D) whether the client is achieving health outcomes

Ans: D

Feedback: During the evaluation phase of care, nurses evaluate how effective care has been in meeting outcome goals. This forms the main basis for evaluation and supersedes

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the client’s knowledge level and adherence. Of course, it is desirable for no adverse effects to be present, but this does not necessarily mean that the client is experiencing benefits that cause them to meet outcomes.

Format: Multiple Selection Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 48, Nursing: Art and Science 13. The nurse is conducting an admission assessment on a client. When collecting data related to medications, the nurse asks, “What medications are you currently taking?” After collecting this information, what other questions should the nurse ask? Select all that apply. A) “Do you feel like you take enough medication, too much, or too little?” B) “What over-the-counter (OTC) medications do you take?” C) “Do you take any herbs, vitamins, or supplements?” D) “Do you take medications safely when you take them?” E) “Who prescribed these medications?”

Ans: B, C

Feedback: Clients often neglect to mention OTC drugs or alternative therapies (e.g., herbals) because they do not consider them to be actual drugs or they may be unwilling to admit their use to the health care provider. Ask clients specifically about OTC drug and alternative therapy use. The nurse must assess whether the client is taking medications safely, but this cannot be determined simply by asking the client if this is so. The name of the prescriber and the client’s perception of doses/quantities are not priorities.

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Format: Multiple Choice Chapter: 4 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 48, Nursing: Art and Science 14. The nurse in the intensive care unit is providing care for a client who was just admitted with multiple trauma. What action should the nurse prioritize with relation to drug therapy? A) Advocate for the lowest effective dose. B) Assess the client’s likelihood of adherence to treatment. C) Educate the client and family about medications. D) Monitor the client’s response to treatment closely.

Ans: D

Feedback: Because the nurse has the greatest direct and continued contact with the client, the nurse is in the best position to detect minute changes that ultimately determine the course of drug therapy—therapeutic success or discontinuation because of adverse or unacceptable responses. This is especially true in a high acuity environment. It would be inappropriate and ineffective to perform education while the client’s health is acutely unstable. Adherence is not a primary concern in this inpatient setting. Advocating for the lowest effective dose is not a priority for this client.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 5 Page and Header: 48, Nursing: Art and Science 15. A nurse is caring for an 84-year-old client. The nurse should plan care in the knowledge of what physiologic difference between this client and younger adult clients? A) decreased blood volume B) thickening of subcutaneous tissue C) increased total body water D) decreased urine output

Ans: A

Feedback: As clients age, the body undergoes many normal changes that can affect drug therapy, such as a decreased blood volume, decreased gastrointestinal (GI) absorption, reduced blood flow to muscles or skin, and changes in receptor site responsiveness. As a person ages, subcutaneous tissue decreases and total body water decreases. In the absence of renal disease, urine output remains relatively steady.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 48, Nursing: Art and Science 16. The nurse is caring for clients who are each prescribed several drugs. Which client should the nurse monitor most closely for adverse medication effects? A) a 7-year-old child with type 2 diabetes B) a middle-aged man who is morbidly obese C) a 17-year-old female who takes oral contraceptives D) the newborn infant who has no known health problems

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Ans: D

Feedback: Clients most likely to have adverse drug reactions include the very young or very old due to physiologic characteristics peculiar to these age groups. Therefore, the newborn infant (even one who is healthy) would be at greater risk than the school-aged child who is at greater risk than the adolescent or middle-aged man.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 48, Nursing: Art and Science 17. Which client should the nurse assess most closely for swallowing difficulties prior to administering an oral medication? A) a client who is emotionally distraught after receiving a negative prognosis B) an older adult diagnosed with Parkinson’s disease C) an older adult client who has an active lower gastrointestinal bleed D) a client who expressed a preference for alternative and complementary therapies

Ans: B

Feedback: Parkinson’s disease constitutes a risk for dysphagia. A GI bleed, emotional trauma, or a preference for CAM is unlikely to have any bearing on the client’s ability to swallow prescribed medications.

Format: Multiple Choice Chapter: 4

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 48, Nursing: Art and Science; 51, Box 4.3 18. After admitting a client to the unit, the nurse is organizing times to administer ordered medications. In addition to the prescriber’s orders, what factor should the nurse prioritize? A) the client’s comfort B) the client’s ethnicity C) the client’s gender D) the client’s age

Ans: A Feedback: Organizing the day and the drug regimen to make it the least intrusive on a client’s comfort can help to prevent errors and improve compliance. Ethnicity, gender, and age should be a consideration when ordering the drug, but after the drug is chosen, it should be administered in a way that will maintain the client’s quality of life.

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C) In older adults, drugs are distributed to a smaller portion of the tissues. D) Drugs are likely to have decreased therapeutic effect

Ans: A

Feedback: As clients age, the body undergoes many normal changes that can affect drug therapy, such as a decreased blood volume, decreased GI absorption, reduced blood flow to muscles or skin, and changes in receptor site responsiveness. They are not released more quickly into circulation or distributed to a smaller portion of tissue. Therapeutic effects are not necessarily diminished.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 48, Nursing: Art and Science 20. The nurse admits a client to the unit and learns that the client has recently been diagnosed with chronic renal failure but has not informed the primary care provider of this diagnosis. What is the nurse’s first priority? A) Administer medications ordered immediately. B) Maintain the client’s confidentiality. C) Call the admitting health care provider immediately. D) Provide teaching about chronic renal failure.

Ans: C

Feedback: Knowledge of the client’s diagnosed renal failure is essential to proper medication ordering because some dosages will need to be decreased, whereas other medications may be contraindicated in this client. The nurse does not breach

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confidentiality when sharing information that impacts needed care to the primary care provider. Teaching about renal failure may be provided at some point, but it is not the priority in this situation. Medications should not be administered until they are appropriately adjusted by a health care provider who is aware of the renal failure diagnosis.

Ans: A, B, C, D

Feedback: Assessing educational level allows the nurse to plan an effective teaching plan. Allergies must be fully assessed before administering any medication to prevent allergic responses. Understanding the client’s current drug use informs the nurse about drugs that may interact or be impacted. Knowing the client’s weight helps ensure correct dosage calculations. The nurse does not normally need to identify the name of the client’s insurance company.

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Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 48, Nursing: Art and Science; 50, Box 4.2 22. A client is admitted to the medical unit for the treatment of an abscess resulting from intravenous drug use. When planning this client’s discharge education with regard to medication use, what nursing diagnosis is most likely? A) unilateral neglect B) ineffective self-health maintenance C) risk for impaired liver function D) deficient fluid volume

Ans: B

Feedback: A client who uses recreational drug intravenously is likely to have ineffective self-health maintenance. There is no reason to believe that the client’s fluid volume will be deficient or that the client will neglect one side of his or her body. Liver damage is more likely in clients who abuse alcohol.

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23. What is the nurse’s main rationale for applying the nursing process in medication therapy? A) Provide opportunities for clients to express their preferences. B) Ensure that care is safe and effective. C) Provide a framework for documenting nursing actions. D) Promote interprofessional collaboration.

Ans: B Feedback: Nurses use the nursing process as a decision-making, problem-solving process to improve the safety and effectiveness of care. The main purposes of the nursing process do not involve giving clients a voice, collaborating, or giving a framework for documentation.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 48, Nursing: Art and Science; 50, Box 4.2 24. The nurse is caring for a client scheduled for surgery this morning who is not to be given anything orally. The nurse reviews the medication administration record and finds that the client has an important medication due, but it is supposed to be given orally. What is the nurse’s best action? A) Give the medication with a small sip of water. B) Give the medication via a different route. C) Hold the medication and put a note on the front of the chart for the surgeon. D) Call the ordering health care provider and clarify administration.

Ans: D

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Feedback: The nurse would consult with the ordering provider to determine whether the medication should be held, given by another route, or taken with a sip of water. Administering the medication with a small sip of water could cause the cancellation of the procedure, either because of the sip of water or because the medication may interfere with anesthesia. The nurse cannot change the route of administration without an order. Holding the medication would constitute a drug error because the medication was not given on time. Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 48, Nursing: Art and Science 25. The nurse admits an older adult client to the emergency room with reports of shortness of breath on exertion and a productive cough. The nurse reviews the client’s current medications, and the client says, “I take one pink pill every morning.” The nurse asks the name and purpose of the drug, and the client responds that they don’t know. What intervention should the nurse implement to minimize the client’s risk”? A) Assess for confusion. B) Assess for cognitive dysfunction. C) Provide medication education. D) Discuss importance of medication compliance.

Ans: C

Feedback: This client is demonstrating ineffective health maintenance because knowledge of what medications are being taken and why they are being taken is essential to the client’s health. Clients should be instructed to carry an up-to-date list of current medications to share with all health care providers. The client is taking medication as ordered, which would rule out risk-prone health behaviors and noncompliance. There is no indication that the client is confused.

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Ans: A, C

Feedback: During the implementation phase, the nurse administers and documents the medication. Effectiveness of the medication is determined during the evaluation phase. Analyzing data occurs when assigning appropriate nursing diagnoses. Collecting a nursing history is part of the assessment stage of the nursing process.

Format: Multiple Selection Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understanding Difficulty: Moderate Integrated Process: Nursing Process Objective: 3

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Page and Header: 48, Nursing: Art and Science 27. A nurse is completing a medication reconciliation on a newly admitted client. Which area(s) are reviewed in the process? Select all that apply. A) alcohol consumption B) nicotine use C) allergies D) caffeine consumption E) level of education

Ans: A, B, C, D

Feedback: Prescription drugs, over-the-counter (OTC) drugs, street drugs, alcohol, nicotine, alternative therapies, and caffeine may have an impact on a drug’s effect. A client’s history of allergies can affect drug therapy. Past exposure to a drug or other allergens can provoke a future reaction or necessitate the need for cautious use of the drug, food, or animal product. Information about the client’s level of education provides a baseline from which the nurse can determine the appropriate types of teaching information to use with the client.

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C) diagnosed with asthma 5 years ago D) expresses concern over memory lapses Ans: C

Feedback: Clients diagnosed with diabetes who are prescribed new antihyperglycemic medication should be assessed for any other chronic conditions. The client’s history is an important element of assessment related to drug therapy because comorbid illnesses and current medications can influence a drug’s effect. The remaining options are appropriate assessment issues but do not affect safety as dramatically.

Format: Multiple Selection Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 48, Nursing: Art and Science 29. After a discussion with the nurse, which statement made by a client best reflects a healthy personal pattern of health care? Select all that apply. A) “I don’t think hospital emergency department are a place to go to seek help with general health care issues.” B) “At the first symptom of a cold, I go to my primary care provider.” C) “Severe bleeding is the only thing that would make me seek immediate care.” D) “I see my eye doctor yearly for a routine eye examination.” E) “I had a colonoscopy when I turned 50 years old.”

Ans: A, D, E

Feedback: Knowing how a client seeks health care provides the nurse with valuable information to include when preparing the client’s teaching plan. Does this client routinely seek follow-up care, or do they wait for emergency situations? Does the client

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tend to self-treat many concerns, or is every problem brought to a health care provider? The statements regarding the appropriateness of emergency department visits, yearly eye examinations, and a routine colonoscopy at age 50 all represent effective personal patterns of health care. Appropriate patterns of health care are not associated with the belief that severe bleeding is the only appropriate reason to seek emergency department care nor is it effective to see a primary care provider with minor health issues like a cold.

Format: Multiple Selection Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 48, Nursing: Art and Science; 48, Box 4.1 30. A nurse is caring for a client who has been admitted to the medical surgical unit. Which nursing question would be appropriate for inclusion in the past history portion of the nursing process? Select all that apply. A) “Are you being treated for any chronic condition?” B) “What is the highest level of education you achieved?” C) “Are you familiar with the placebo effect?” D) “Are you currently taking any herbal therapies?” E) “Do you smoke tobacco?”

Ans: A, B, D

Feedback: Past history focuses on chronic conditions; drug use, including prescription, OTC, herbal, and street drugs; allergies; level of education; level of understanding of disease and therapy; social support; financial support; and pattern of health care. Comfort measures include the placebo effect, managing side effects, and lifestyle adjustments.

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Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 52, Medication Errors; 53, Box 4.5 31. A nurse is reviewing the six rights of medication administration prior to administering medications to a client. Which medication right is best associated with the phrase, “If it isn’t written, it didn’t happen”? A) right drug B) right time C) right recording D) right preparation

Ans: C

Feedback: Right recording requires that one must always document drug administration. If it isn’t written, it didn’t happen. Document the information in accordance with the local requirements for recording medication administration after assessing the client, making the appropriate nursing diagnoses, and delivering the correct drug, by the correct route, in the correct dose, and at the correct time. Right drug relates to preventing medication errors; always check to make sure the drug you are going to administer is the one that was prescribed. Right preparation refers to knowing the specific preparation required before administering any drug. Right timing takes into account all aspects of pharmacokinetics to determine a dosing schedule that will provide the needed therapeutic level of the drug.

Test Generator Questions, Chapter 5, Dosage Calculations Format: Multiple Choice

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Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 58, Measuring Systems 1. The nurse is calculating a drug dosage and needs to convert the dose from micrograms to milligrams. What measurement system is the nurse using? A) metric system B) apothecary system C) European system D) avoirdupois system

Ans: A

Feedback: The metric system is the most widely used system of measurement in the world; it is based on the decimal system. The gram is the basic unit of solid measure and the liter unit of liquid measure. The apothecary system uses the grain as the basic unit of solid measure. The avoirdupois system uses ounces and grains, but it is mostly used by drug manufacturers for bulk medications. The metric system is not referred to as the European system.

Format: Multiple Selection Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 61, Calculating Dose

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2. The nurse teaches a parent the importance of administering appropriate dosages of acetaminophen when the client’s infant has a fever. What information should the nurse provide to this client? Select all that apply. A) “Children’s dosages will change with time as they grow.” B) “An infant’s dose of acetaminophen is about ½ of an adult dose.” C) “It is important to give the right dose to prevent toxic effects of the medication.” D) “Infant’s and children’s doses should be based on their weight or age.” E) “In most cases, infants cannot be given medications because of their immature organs.”

Ans: A, C, D

Feedback: A child’s dose is never based on an adult’s dose. A child’s dosage is based on weight and age and will change with age as they grow. A larger than directed dosage can result in toxic effects of this medication. Infants can safely receive medication, but caution must be exercised with regard to dose.

Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 64, Summary 3. What characteristic is used most frequently to determine dosage for an 8-year-old client? A) age B) muscle mass C) weight D) surface area

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Ans: C

Feedback: For most drugs, clients 18 years of age and under require doses different from those for adults due to the way their bodies handle drugs and the way that drugs affect their tissues and organs. Most pediatric medications are dosed by weight.

Format: Fill-in-the-Blank Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 64, Pediatric Considerations 4. The nurse receives a new medication order for a client to administer 300 mg of medication per day in equally divided doses every 8 hours. How many milligrams of the drug should the nurse administer for each dose?

Ans: 100 mg

Feedback: Because there are 24 hours in a day, giving a drug every 8 hours would mean giving the drug three times a day. Because the total daily dose is 300 mg, dividing that dose by 3 would mean each dose should be 100 mg.

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5. A health care provider (HCP) orders 500 mL of IV solution to be administered over 8 hours. If the IV infusion set delivers 15 drops per mL, how many drops per minute should the nurse administer to the client?

Ans: 15 drops/min

Feedback: If a client was to receive 500 mL in 8 hours, dividing 500 by 8 would mean that the client would receive 62.5 mL in 1 hour or 60 minutes. Setting up the equation, 15 drops/mL/X equals 62.5 mL/60 minutes; cross-multiplying, the answer will be 15 drops/min.

Format: Fill-in-the-Blank Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 62, Calculating Dose 6. The health care provider (HCP) orders a maintenance dose of oral aminophylline, 3 mg/kg every 6 hours. The client weighs 50 kg. How many milligrams should the nurse administer to the client in a 24-hour period? Ans: 600 mg Feedback: The client’s weight times the amount of medication in milligrams per dose: 50 kg × 3 mg/kg = 150 mg per dose. The client is to receive a dose every 6 hours. The number of hours in a day divided by the number of hours separating each dose supplies the number of dosages the client receives per day: 24 hours ÷ 6 hours between doses = 4 doses per day. If each dose is 150 mg and the client receives 4 of these doses a day, the total amount of medication received is 150 mg × 4 daily doses = 600 mg.

Format: Multiple Selection

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Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 64, Summary; 59, Table 5.2 7. Which conversion(s) between measurement systems are correct? Select all that apply. A) 2 kilogram (kg) = 4.4 pounds (lb) B) 480 milliliter (mL) = 2 cups (c) C) 1 tablespoon (tbsp) = 2 teaspoons (tsp) D) 2 grams (g) = 2,000 milligrams (mg) E) 15 milliliters (mL) = 1 tablespoon (tbsp)

Ans: A, B, D, E

Feedback: 1 kg = 2.2 lbs; 240 mL = 1 c; 1 tbsp = 3 tsp; 1 g = 1,000 mg; 30 mL = 2 tbsp.

Ans: 125 drops/min

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Feedback: If a client was to receive 1,000 mL in 8 hours, dividing 1,000 by 8 would mean that the client would receive 125 mL in 1 hour or 60 minutes. Setting up the equation, 60 drops/mL ÷ X = 125 mL/60 minutes; cross-multiplying, the answer is 125 drops/min.

Ans: Two tablets Feedback: Convert 1 g to mg by multiplying 1 g times 1,000 mg. There are 500 mg in each tablet. Dividing the 1,000 mg prescribed dosage by 500 mg available dosage, the answer is two tablets.

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10. The nurse begins administering 500 mL of 5% dextrose and water solution at 01:00 to run over 4 hours. At 02:00, the nurse administers 80 mg gentamicin in 50 cc normal saline to infuse over 30 minutes. How many milliliters of fluid will the nurse administer to the client between 02:00 and 03:00?

Ans: 175 mL

Feedback: The client is receiving 500 mL over 4 hours. To determine how much fluid is infusing per hour = 500 mL ÷ 4 = 125. In addition to the 125 mL of IV solution, the client also receives 50 mL of gentamicin during the 02:00 to 03:00 hour. 125 mL + 50 mL = 175 total mL of fluid received during this hour.

Ans: 2.375 mg

Feedback: This order requires 25 mcg of medication for every 1 kg of body weight. The client weighs 95 kg. To determine total dosage, multiply weight times mcg of medication: 25 × 95 = 2,375 mcg. Convert mcg to mg by moving the decimal three places to the left, or you can divide 2,375 by 1,000 because there are 1,000 mcg per mg.

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Format: Fill-in-the-Blank Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 61, Calculating Dose 12. The nurse is preparing medication for a 30-month-old child with otitis media in the right ear. The child weighs 33 pounds. The health care provider (HCP) has ordered cephalexin, 50 mg/kg/d in equally divided doses every 8 hours. The medication concentration is 250 mg/5 mL. How many milliliters should the nurse give the toddler for each dose?

Ans: 5 mL

Feedback: To calculate the correct dosage, the nurse first converts the child’s weight from pounds to kilograms by dividing weight in pounds by 2.2 (2.2 lb = 1 kg). 33 pounds ÷ 2.2 pounds/kg = 15 kg. The child is to receive 50 mg for every kilogram. To determine this child’s dosage, multiply weight in kilograms times daily dose (15 kg × 50 mg/kg = 750 mg). Thus, 750 mg is to be administered in equally divided dosages every 8 hours or three times a day. 750 mg ÷ 3 = 250 mg/dose. There is 250 mg in 5 mL of medication so the client would be given 5 mL.

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Page and Header: 61, Calculating Dose 13. An adolescent is admitted to the intensive care unit with diabetic ketoacidosis. The nurse prepares a continuous insulin infusion of 100 units (U) regular insulin in 500 mL normal saline. When documenting this medication, how many units of regular insulin will this client receive per milliliter of IV solution? A) 0.175 U/mL B) 0.2 U/mL C) 0.25 U/mL D) 0.5 U/mL

Ans: B

Feedback: The problem tells us there is 100 U/500 mL. To determine calculate dosage, use the ratio method. 100 U/500 mL = X/1 mL; then cross-multiply to get 500 X = 100; then divide both sides by 500 to get X = 0.2 U/mL.

Format: Fill-in-the-Blank Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 60, Conversion Between Systems 14. The client drinks 18 ounces of fluid at lunchtime. How many milliliters of intake should the nurse document?

Ans: 540 mL

Feedback: 1 ounce = 30 mL. Using the ratio-and-proportion method: 1 oz/30 mL = 18 oz/X. Cross-multiply to determine the client drank 540 mL of fluid.

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Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 60, Conversion Between Systems 15. The pediatric nurse is caring for a child who weighs 44 pounds. The health care provider (HCP) has ordered methylprednisolone sodium succinate, 0.03 mg/kg/d IV in normal saline. How many milligrams of medication will the nurse prepare? A) 6.5 B) 6 C) 0.65 D) 0.6 Ans: D

Feedback: First convert the child’s weight to kilograms by dividing 44 pounds by 2.2 kg/1 pound = 20 kg. Multiply the dosage times the child’s weight: 20 kg × 0.03 mg/kg/d = 0.6 mg/d.

Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 61, Calculating Dose 16. The nurse is to infuse 100 mL of 5% dextrose and water solution containing an IV antibiotic over 30 minutes. The infusion set delivers 10 gtt/mL. How many drops per minute will the nurse administer?

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A) 33 gtt/min B) 30.3 gtt/min C) 30 gtt/min D) 3 gtt/min

Ans: A

Feedback: Use the following ratio to determine how many drops of fluid to administer per minute:

drops / minute =

mL solution prepared ´ drops delivered per mL time in minutes

Using the information from this problem:

drops / minute =

100 ´10 1,000 = = 33.3 30 30

Because it is not possible to deliver 0.3 drops, round 33.3 to 33 gtt/min.

Format: Fill-in-the-Blank Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 61, Calculating Dose 17. An 80-year-old client with internal bleeding is admitted to the emergency room after a motor vehicle accident. The health care provider (HCP) has ordered 2 units of packed red blood cells (1 unit is 250 mL) to infuse over 1 hour each. The drip rate on the blood administration set is 10 gtt/mL. The nurse administers how many drops per minute to infuse the blood as ordered?

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Ans: 42

Feedback: Use the following ratio to determine how many drops of fluid to administer per minute:

drops / minute =

mL solution prepared per hour ´ drops delivered per mL 60 minutes /1 hour

Using the information from this problem:

drops / minute =

250 ´10 2,500 = = 41.7 60 60

Because it is not possible to deliver 0.7 of a drop, round 41.7 to 42 drops/min. Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 61, Calculating Dose 18. The health care provider (HCP) prescribes 250 mg of a drug. The information on the drug vial says that the concentration is 500 mg/mL. How much of the drug will the nurse prepare? A) 0.25 mL B) 0.33 mL C) 0.5 mL D) 0.75 mL

Ans: C

Feedback: To determine the amount to prepare: 500 mg/1 mL = 250 mg/X. Crossmultiply to determine the nurse will prepare 0.5 mL.

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Format: Fill-in-the-Blank Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 3 Page and Header: 61, Calculating Dose 19. An 81-year-old client diagnosed with congestive heart failure has been sent to a cardiologist who prescribes digoxin 125 mcg PO every morning. The pharmacy dispenses pills that contain 0.25 mg of digoxin. How many pills should the nurse teach the client to take every morning? A) 2 B) 1.5 C) 1 D) 0.5

Ans: D

amount of drug available amount of drug prescribed = 1 tablet number of tablets to give Feedback: 125 mcg = 0.125 mg. 0.25 mg/1 tablet = 0.125 mg dose/X. Cross-multiply to determine 0.5 or 1/2 of a tablet is to be taken daily. The nurse may request the pharmacy dispense a different concentration to prevent the client from having to cut the tablet in half.

Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process

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Objective: 3 Page and Header: 61, Calculating Dose 20. A client with diabetic ketoacidosis is to receive a continuous infusion of regular insulin. The health care provider orders 1 L of 5% dextrose and water solution to run at 150 mL/h once the client’s blood glucose has reached 250 mg/dL. The drip factor of the tubing is 15 gtt/mL. How many drops per minute will the nurse deliver? A) 0.25 gtt/min B) 62 gtt/min C) 37 gtt/min D) 250 gtt/min

Ans: C

Feedback: Use the following ratio to determine how many drops of fluid to administer per minute:

drops / minute=

mL solution prescribed per hour ´ drops delivered per mL 60 minutes /1 hour

Using the information from this problem:

150 drops / minutes =

mL gtts ´15 hour mL = 2, 250 = 37.5 gtts / min 60 60

37.5 can be rounded to 37 or 38 gtt/min.

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Page and Header: 61, Calculating Dose 21. A client has orders to receive 2 L of IV fluid over a 24-hour period with ½ this amount to be infused in the first 10 hours of treatment. How many milliliters per hour will the nurse administer during the first 10 hours of the infusion?

Ans: 100 mL/h

Feedback: ½ of the 2 L is to infuse in the first 10 hours. ½ of 2 = 1 L; 1 L = 1,000 mL to infuse over 10 hours = 100 mL/h.

Format: Fill-in-the-Blank Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 60, Conversion Between Systems 22. A client is going to have bowel surgery in the morning. The health care provider (HCP) orders 500 mL of PEG 3350/electrolytes bowel prep to be administered at 17:00. How many liters should the nurse administer? Round your number to the nearest tenth.

Ans: 0.5 L

1L X = Feedback: 1,000 mL 500 mL Cross-multiply to learn 500 mL = ½ or 0.5 L.

Format: Fill-in-the-Blank Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 61, Calculating Dose 23. The client returns from the postanesthesia care unit (PACU) with the following order: morphine 3 mg IV every 2 hours as needed for relief of pain. The vial reads morphine, 4 mg/mL. How many milliliters of morphine will the nurse administer? Round your number to the nearest hundredth.

Ans: 0.75 mL

amount of drug available amount of drug prescribed = volume available volume to administer Feedback: Using the figures from this problem: 4 mg/1 mL = 3 mg/X. Cross-multiplying yields 0.75 mL.

Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 61, Calculating Dose 24. A client is admitted with a deep vein thrombosis in the left calf. The health care provider (HCP) orders heparin 7,500 units subcutaneously every 12 hours. The medication vial reads heparin, 10,000 units/mL. How many milliliters does the nurse administer? A) 0.5 mL B) 0.75 mL

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C) 1 mL D) 1.25 mL

Ans: B

amount of drug available amount of drug prescribed = volume available volume to administer Feedback: Using the information supplied by the problem: 10,000 units/1 mL = 7,500/X. Crossmultiplying yields X = 0.75 mL for each dose.

Format: Fill-in-the-Blank Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 61, Calculating Dose 25. A client with an acute myocardial infarction is admitted to the coronary care unit. The health care provider (HCP) has ordered heparin 25,000 units in 250 mL normal saline to infuse at a rate of 600 units/h. The nurse sets the infusion pump to deliver how many milliliters in an hour?

Ans: 6 mL/h

Feedback: First determine the number of units per mL = 25,000 units/250 mL = 100 units/1 mL. Next use the ratio and proportion method to determine the number of milliliters needed to supply 600 units/h. 100 units/1 mL = 600 units/X. Cross-multiplying yields 6 mL needed every hour to supply the required dose.

Format: Multiple Choice

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Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 60, Conversions Between Systems 26. A client has not had a bowel movement for 4 days and has been prescribed milk of magnesia 2 teaspoons orally as needed for relief of constipation. How many milliliters should the nurse administer? A) 30 mL B) 7.5 mL C) 10 mL D) 15 mL

Ans: C

Feedback: Use the ratio and proportion method to convert from household system to metric system. 5 mL/1 tsp = X mL/2 tsp. Cross-multiplying yields 10 mL = 2 tsp.

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Ans: 16:00 Feedback: The rate of the infusion is 125 mL per hour. To determine how long each bag will take to infuse, divide the contents by the rate: 1,000 mL ÷ 125 mL/h = 8 hours. 16:00 is 8 hours after 08:00. The fact that the total infusion volume is 3,000 mL does not impact this particular calculation.

Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 58, Measuring Systems 28. The nurse recognizes that what system is being used when seeing a medication ordered in teaspoons? A) apothecary B) metric C) household D) avoirdupois

Ans: C

Feedback: The household system is the measuring system that is found in recipe books. Although efforts have been made in recent years to standardize these measuring devices, wide variations have been noted in the capacity of some of them. Clients need to be advised that flatware teaspoons and drinking cups vary tremendously in the volume that they contain. A flatware teaspoon could hold up to two measuring teaspoons of quantity. When a client is using a liquid medication at home, it is important to clarify that the measures indicated in the instructions refer to a standardized measuring device.

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The apothecary system used minims as the basic measure of liquid and is rarely used today. The metric system uses liters as the basic unit of measurement for fluid, and the avoirdupois system uses ounces with a different conversion amount.

Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 58, Measuring Systems 29. The nurse is calculating the client’s intake and output record and converts ounces to milliliters. What systems is this nurse converting from and to? A) from household to metric B) from metric to household C) from household to apothecary D) from apothecary to avoirdupois

Ans: A

Feedback: Ounces can be either household or avoirdupois, although they are not equal measurements, and milliliters is a metric measurement. Since avoirdupois to metric is not an available choice, the correct answer is household to metric.

Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 3 Page and Header: 64, Pediatric Considerations 30. A pediatric nurse is reading new medication orders for a school-aged client. How should the nurse best determine the correct dosage? A) Consult a nomogram using body surface area. B) Confirm the child’s age and apply Young rule. C) Apply Fried rule. D) Weigh the client and apply Clark rule.

Ans: A

Feedback: The most accurate means of determining a pediatric drug dosage is a nomogram using body surface area because the weight and body surface area of two children who are of the same age can be significantly different. Young rule, Fried rule, and Clark rule are rarely used today unless no other method will suffice for a specific drug.

Format: Fill-in-the-Blank Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 61, Calculating Dose 31. The nurse determines a child’s body surface area is 0.4 m2 and the average adult dosage of the medication is 500 mg. The medication is supplied in liquid form with 500 mg/5 mL. How many milliliters should the nurse administer? Round your answer to the nearest hundredths.

Ans: 1.16 mL

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Feedback: The formula for calculating the child’s dose using body surface area is surface area in m2 divided by 1.73 and then multiplied by adult dosage. Using the information supplied in this problem (0.4 ÷ 1.73) × 500 mg = 115.6 mg. Using the ratio and proportion method, 500 mg/5 mL = 115.6 mg/X mL; cross-multiplying yields 1.16 mL for the nurse to administer.

Format: Multiple Choice Chapter: 5 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 60, Conversion Between Systems 32. The health care provider (HCP) orders acetaminophen 15 mg/kg q4 hours PRN (as needed) for an infant’s pain. The drug is supplied with 160 mg/5 mL. The infant weighs 12 pounds. How many milliliters of medication should the nurse administer? Round your answer to the nearest tenths.

Ans: 2.6 mL

Feedback: Begin by converting the infant’s weight to kilograms (12 pounds ÷ 2.2 pounds/kg = 5.45 kg). The order says to give 15 mg/kg. To determine this child’s dosage, multiply weight and 15 mg/kg (5.45 kg × 15 mg/kg = 81.75 mg/dose). Finally, use the ratio and proportion method to calculate how to prepare the medication: 160 mg/5 mL = 81.75 mg/X mL; cross-multiplying yields 2.55 mL (rounded to 2.6 mL).

Test Generator Questions, Chapter 6, Challenges to Effective Drug Therapy

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Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 68, Consumer Awareness 1. A client who has been prescribed a new medication tells the nurse, “I’ve heard about another drug on TV, and I believe I’d rather be prescribed that one”. What is the nurse’s best response to address the client’s concern? A) “I’ll share your concern with your primary care provider (PCP).” B) “Let’s discuss what you’ve heard and seen on TV about this other medication.” C) “The advertisements on TV are seldom as reliable as they are made out to be.” D) “Trust me when I say, this is the best medication for your problem.”

Ans: B

Feedback: Access to information has become so broad that consumers are often overwhelmed with details, facts, and choices that affect their health care. The client often comes into the health care system influenced by advertising, the internet, and the alternative therapy industry. Many clients no longer unquestioningly accept whatever medication is selected for them. On the positive side, this can result in the opportunity to open up the dialogue for a discussion about treatments between the client and the health care provider. The nurse can alert the PCP to the client’s concerns but should discuss the issues with the client first. The remaining options could be interrupted as patronizing and/or condescending.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 4 Page and Header: 72, Emergency Preparedness for Bioterrorism and Pandemics 2. The nurse is applying the Centers for Disease Control and Prevention (CDC) recommendations for the possibility of bioterrorism. What action should the nurse perform? A) Post updated information on signs and symptoms of infections caused by biological agents. B) Provide guidelines for treating clients exposed to, or potentially exposed to, biological agents. C) Remain current on recognition and treatment of infections caused by biological weapons. D) Advocate for increased funding for research involving bioterrorism and client treatment.

Ans: C

Feedback: Nurses need to remain current about recognition of and treatment for those exposed to biological weapons because nurses are often called upon to answer questions, reassure the public, offer educational programs, and serve on emergency preparedness committees. The CDC posts updated information on signs and symptoms of infections caused by biological agents that nurses would read. The CDC also provides guidelines for how to treat clients exposed to biological agents, and the nurse must remain current on this information. Although nurses could advocate for funding, this is not usually the role of the nurse.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process

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Objective: 4 Page and Header: 72, Emergency Preparedness for Bioterrorism and Pandemics 3. A nurse’s learning goals for the year include reviewing the most up-to-date information about emergency preparedness related to bioterrorism agents. What should the nurse do? A) Read textbooks devoted to the topic. B) Review best practices around triage and emergency care. C) Read journal articles about bioterrorism agents. D) Visit the Centers for Disease Control and Prevention (CDC) website.

Ans: D

Feedback: The most current information will be found on the CDC website because new information can be posted immediately, whereas textbooks and journal articles take time to print. There are many principles of responding to bioterrorism that are not addressed by standard emergency practices.

Format: Multiple Selection Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 70, Alternative Therapies and Herbal Medicine 4. A 22-year-old client newly diagnosed with multiple sclerosis (MS) calls the clinic and tells the nurse that they are about to start a weight loss program that includes an herbal supplement but wants to know if it is safe first. The nurse has encouraged the client to discuss this with the health care provider. What area of discussion should the nurse prioritize? Select all that apply. A) use of acupuncture in this application B) need for Food and Drug Administration (FDA) control

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C) amount of weight loss needed D) use of over-the counter drugs E) interaction with prescription medications

Ans: B, D, E

Feedback: Herbal or alternative therapies are considered by the FDA to be dietary supplements and are not as strictly regulated by the FDA as compared to medications. Dietary supplements are substances that contain some dietary ingredient(s). Some examples are vitamins, minerals, amino acids, and herbs. Even though they are not categorized as drugs or medications, herbal medicines are not benign. They can produce unexpected effects and toxic reactions, interact with prescription or OTC drugs, and contain various unknown ingredients that alter their effectiveness and toxicity. The challenge for the clinician is to balance the therapies that the client wishes to use with the medical regimen that is prescribed. This may involve altering doses or timing of various drugs. While appropriate areas of assessment, weight loss goals and identification of nonmedication alternatives are not priorities for this situation.

Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 72, Emergency Preparedness for Bioterrorism and Pandemics 5. A nurse working with a town’s Crisis Preparedness committee will find regularly updated pandemic-related information under the “Emergency Preparedness” tab on what commonly accessed website? A) Centers for Disease Control and Prevention (CDC) B) Department of Health Services (DHS) C) American Medical Association (ADA) D) World Health Organization (WHO)

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Ans: A

Feedback: CDC’s Public Health Emergency Preparedness (PHEP) cooperative agreement program is a critical source of funding, guidance, and technical assistance for state, local, tribal, and territorial public health departments to strengthen their public health preparedness capabilities. The CDC website also has up-to-date information about pandemics in the Emergency Preparedness tab section. While the other options may represent informational sites, they are not necessarily accessed under that tab.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 1 Page and Header: 68, Consumer Awareness 6. A client calls the clinic and asks the nurse for a drug that was advertised on TV. The client is keen to experience the benefits described in the commercial. What is the nurse’s best response? A) “I’m glad that you want to be involved in treatment decisions but you are not qualified to decide what medications are best for your condition.” B) “It’s important to remember that drug advertisements emphasize the positive effects of drug therapy and not the adverse effects or contraindications.” C) “You need to remember that the drugs being advertised are much more expensive than other drugs that have the same effect and that aren’t advertised.” D) “I’ve seen those advertisements and I would want to take that medication too if I had the condition it was designed to treat.”

Ans: B

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Feedback: It would be important for the nurse to remind the client that advertisements always emphasize the positive effects of drug therapy. The client should not be discouraged from contributing to the plan of care by being told they are not adequately qualified to make decisions because no one is more qualified to make decisions about their own body. Although the drug may be more expensive, this is not a reason to choose or avoid a medication that could be more effective. Agreeing with the client is not meeting the nurse’s obligation to teach and inform.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 68, Consumer Awareness; 69, Box 6.1 7. The clinic nurse is talking with a client about information concerning a medication that the client read about online. What is the nurse’s best action? A) Encourage the client to seek information about drugs from a pharmacist. B) Explain that information obtained from the internet is not always accurate. C) Offer the client a drug reference guide to read and learn more about the drug. D) Interpret the information and explain it in terms that the client will understand.

Ans: D

Feedback: The internet can be a good reference for drug information. However, the amount and reliability of the information can be overwhelming. The nurse should always try to interpret the information and explain it in terms that the client will understand. A pharmacist is a good resource person but may not be able to teach from a holistic perspective. Drug reference guides may be hard for the client to understand, and they would still need someone to interpret the information.

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Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 73, Drug Misuse and the Opioid Crisis; 74, Table 6.3 8. The triage nurse in the emergency department admits a client in distress. The client’s parents attribute the client’s distress to amphetamine use. What assessment finding would best corroborate this parent’s suspicion? A) blood pressure 196/117 mm Hg B) heart rate 96 beats/min, regular rhythm C) drowsiness, arousable by touch D) dilated pupils, unresponsive to light

Ans: A

Feedback: Increases in blood pressure, tachycardia, insomnia, and restlessness are symptoms of amphetamine abuse. Pupil response is not normally affected by amphetamines, unlike narcotics. The client is more likely to be agitated than drowsy.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 72, Emergency Preparedness for Bioterrorism and Pandemics

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9. A nurse seeking information regarding current research associated with exposure to biological weapons can be accessed under “Bioterrorism” in the drop-down menu at what website? A) www.ama-assn.org B) www.who.int C) www.dhs.gov D) www.cdc.gov

Ans: D

Feedback: The CDC has worked diligently to establish guidelines for treating possible exposure to biological weapons. For complete information on presenting signs and symptoms, diagnoses, and current research in this area, go to www.cdc.gov and click on “Emergency Preparedness,” then click on “Bioterrorism” in the drop-down menu. The other sites may provide information but not necessarily under that heading.

Format: Multiple Selection Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 73, Drug Misuse and the Opioid Crisis 10. Which individual(s) are at an increased risk for the misuse of prescription medications? Select all that apply. A) a 40-year-old client who experienced a compound fracture of the left femur as a result of a fall B) a 28-year-old client who works at a small family-owned pharmacy C) a 60-year-old client who was diagnosed with osteoarthritis 10 years ago D) a 17-year-old client who recently began classes at a college 100 miles away from home

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E) the 50-year-old person serving as the caregiver of an 81-year-old client diagnosed with fibromyalgia

Ans: A, B, C, E

Feedback: Some people misuse prescription drugs following an injury, when confronted with chronic pain, when their occupation puts them in contact with readily available drugs, or when someone else in the home is using a prescription drug. The 17-year-old client’s situation may produce emotional stressors but misuse of prescription drugs is not a significant risk.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 75, COVID-19 and the Health Care System 11. A nurse is preparing a presentation for a group of local government officials about the effects of the COVID-19 pandemic. What consequence should the nurse identify as having created the greatest issue for the physical health of the general population? A) transition to telehealth for out client visits B) increase of uninsured citizens C) need for social distancing D) mail-order medication delivery

Ans: B

Feedback: Many people in the United States have medical and prescription insurance linked to employment. Due to the pandemic, millions of Americans were without work and/or were furloughed from their work. It has been proposed. There is concern that

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state and federal laws and regulations have not yet fully solved the issue of securing medical and prescription insurance for unemployed people, and the surge of uninsured people during and after the pandemic may negatively impact population health. While the other options present social dilemmas, financial health care coverage has the potential for greatest physical harm.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 68, Consumer Awareness 12. The nurse is teaching a group of clients how to be critical consumers of drug advertising. What should the nurse teach these clients about the way drugs are marketed? A) Adverse effects are deliberately excluded from drug advertisements. B) Broadcasters and publishers who carry drug advertisements receive a set proportion of drug profits. C) The manufacturer’s primary motivation is to increase sales of the drug. D) Drug advertising is illegal, but manufacturers are willing and able to pay any resulting fines.

Ans: C

Feedback: The nurse should ensure that clients know manufacturer’s main motivations for buying advertising. Advertising is not illegal; the Food and Drug Administration regulates the information that needs to be contained within medication ads, which must include main adverse effects. Broadcasters do not receive “kickbacks” from drug sales.

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Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 68, Consumer Awareness; 69, Box 6.1 13. When evaluating information accessed over the internet, what important question should the nurse encourage clients to ask? A) Is the information anecdotal? B) Does the website originate from the United States? C) Does this information address over-the-counter medications? D) How many clients have had input into the information?

Ans: A

Feedback: Many people do not know how to evaluate the drug-related information that they can access over the internet. Is it accurate or anecdotal? is an important concept for the nurse to teach the client to assess to verify the accuracy of the information. Critical appraisal is needed with regard to both OTC and prescription medications. The geographic origin of information is not a priority. Input from clients does not necessarily create credibility.

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14. Clients’ access to drug information has changed the way that clients interact with nurses and other health care providers. What client best exemplifies this trend? A) a client who shares information from a research report with the health care provider B) a client who tries to contact a drug company to see what the company’s latest reports say C) a client who challenges the health care provider with their own research D) a client who self-prescribes OTC drugs rather than obtaining prescriptions from the health care provider

Ans: C

Feedback: Access to consumer advertising, mass media health reports, and the internet influence some clients to request specific treatments, to question therapy, and to challenge the health care provider. Consumers do not generally read research reports from medical facilities and contact drug companies to see what their reports say, and they cannot self-medicate because many of these drugs require a prescription to obtain them.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 68, Consumer Awareness 15. A client has approached the nurse with varied and detailed questions about an emerging viral infection that was identified for the first time a few months earlier. The nurse’s unfamiliarity with this infection may have what effect on the nurse–client relationship? A) The client may view the nurse as not being a credible source. B) The client may view the nurse as part of the problem rather than the solution.

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C) The client may demonstrate anger toward the nurse. D) The client is likely to sever contact with the nurse.

Ans: A

Feedback: Some health care providers have learned to deal with the “disease of the week” as seen in the media; others can be unprepared to deal with what was presented and may lose credibility with the client. A loss of credibility is more likely than overt anger or an absolute end to the relationship.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 70, Alternative Therapies and Herbal Medicine 16. Today, an abundance of information is available in the health care arena for consumers, resulting in the nurse encountering clients who have a much greater use of what? A) over-the-counter (OTC) therapies B) alternative therapies C) prescription drugs D) off-label drugs

Ans: B

Feedback: The client now presents into the health care system burdened with the influence of advertising, the internet, and a growing alternative therapy industry. Many clients no longer calmly accept whatever medication is selected for them. Indeed, an increasing number of clients are turning to alternative therapies with the belief that they

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will treat their disorder and reduce risk of adverse effects. Although more prescription drugs are used today, that is not related to abundant information. No indication exists of an increase in use of OTC or off-label drugs.

Format: Multiple Selection Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 70, Costs of Health Care and the Importance of Patient Teaching 17. A client’s care will be provided in the home setting. Because the client will be treated in this setting, the nurse should address what topics during health education? Select all that apply. A) OTC medications that can be temporarily substituted for prescriptions B) generic names of medications C) OTC drugs that need to be avoided D) prevention and management of adverse effects E) methods for calculating safe dosages

Ans: B, C, D

Feedback: The responsibility of meeting the tremendous increase in teaching needs of clients frequently resides with the nurse. Clients need to know exactly what medications they are taking (generic and brand names), the dose of each medication, and what each is supposed to do. Clients also need to know what they can do to alleviate some of the adverse effects that are expected with each drug (e.g., small meals if gastrointestinal upset is common, use of a humidifier if secretions will be dried and make breathing difficult), which OTC drugs or alternative therapies they need to avoid while taking their prescribed drugs, and what to watch for that would indicate a need to call the health care provider. Clients must be taught to follow their drug regimens carefully, but

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calculating doses is not normally a component of management in the home. Clients must be taught to never substitute for their prescriptions.

Format: Multiple Selection Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 70, Alternative Therapies and Herbal Medicine 18. The nurse is teaching a client about some of the important considerations related to the use of alternative therapies. The nurse should include what information? Select all that apply. A) The Food and Drug Administration (FDA) does not test or regulate active ingredients. B) The testing process for alternative therapies is slightly shorter than that of prescription drugs. C) The dosage contained in each tablet may vary greatly. D) No alternative therapy has yet been scientifically found to be effective. E) Advertising of alternative products is not as restrictive or accurate.

Ans: A, C, E

Feedback: Alternative products are not controlled or tested by the FDA, and advertising is not as restrictive or accurate as with classic drugs. The strength of tablets may vary within the bottle depending on the conditions under which they were grown. While some alternative therapies have been found to be effective, there are others who have not been studied. There is no mandated testing process for alternative therapies.

Format: Multiple Choice Chapter: 6

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 70, Alternative Therapies and Herbal Medicine 19. The nurse is providing teaching to a client who takes a complex regimen of herbal therapies. What education should the nurse prioritize? A) Herbs can interact with over-the-counter (OTC) and prescription drugs. B) Herbal supplements sometimes contain unknown ingredients. C) Herbal supplements are sometimes more expensive than medications. D) It is possible to overdose on herbs, even though their natural ingredients are nontoxic.

Ans: A

Feedback: Herbal therapies can produce unexpected adverse effects and toxic reactions, can interact with prescription drugs, and can contain various unknown ingredients that alter the therapies’ effectiveness and toxicity. In terms of priority, however, the possibility of interactions is a safety risk and is more important than the fact that there are sometimes unknown ingredients. It is inaccurate to characterize all herbs as “nontoxic.” Issues of cost are a minor concern since this does not affect safety.

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20. When clients do not understand the information provided with their medication, who is best placed to help them sort through and comprehend the meaning? A) caregiver B) nurse C) client D) health care provider

Ans: B

Feedback: Many pharmacies provide written information with each drug that is dispensed, but trying to organize these sheets of information into a usable and understandable form is difficult for many clients and caregivers. The nurse is often the one who needs to sort through the provided information to organize, simplify, and make sense of it for the client.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 70, Alternative Therapies and Herbal Medicine 21. The nurse is providing an in-service on alternative therapies for peers and explains that the term “alternative therapies” includes what? A) holistic drug therapy B) hospice care C) nondrug measures D) home care

Ans: C

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Feedback: Herbal medicines and alternative therapies are found in ancient records and have often been the basis for discovery of an active ingredient that is later developed into a regulated medication. Today, alternative therapies can also include nondrug measures, such as imaging and relaxation. Holism is not limited to alternative therapies. Hospice and home care are not considered alternative therapies.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 70, Costs of Health Care and the Importance of Patient Teaching 22. The client calls the clinic and talks to the nurse saying, “I found the same drug the provider prescribed on the internet and it is much cheaper but out of the country. Is it safe for me to order my drug from this site?” What is the nurse’s best response? A) “It is usually safe to order drugs online if it is a reliable site.” B) “Most drugs ordered online come from another country and are safely used there.” C) “The drug you get will be the same chemical prescribed but the packaging may differ.” D) “The Food and Drug Administration (FDA) has issued warnings to consumers about buying these drugs.”

Ans: D

Feedback: The FDA has begun checking these drugs when they arrive in this country and have found many discrepancies between what was ordered and what is in the product, as well as problems in the storage of these products. Some foreign brand names are the same as brand names in this country but are associated with different generic drugs. The FDA has issued many warnings to consumers about the risk of taking

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some of these drugs without medical supervision, reminding consumers that they are not protected by U.S. laws or regulations when they purchase drugs from other countries.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 73, Protecting the Environment; 75, Box 6.2 23. A client has a medicine cabinet that is full of partial and expired prescriptions, many which are several years old. How should the nurse instruct the client to deal with these drugs? A) Soak the drugs with water and then put them in the trash. B) Flush drugs down the toilet with plenty of water. C) Store the unused drugs in a location other than the medicine cabinet. D) Return the drugs to pharmacy or hospital that accepts such drugs.

Ans: D

Feedback: Clients should go through their medicine cabinet annually and dispose of drugs no longer used. Ideally, clients should return drugs to designated sites. This is preferable to putting the drugs in the trash. The client should flush prescription drugs down the toilet only if the accompanying information specifically instructs that this is safe to do.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 2 Page and Header: 69, Over-the-Counter Drugs 24. The nurse receives a call from a distressed parent saying, “My child swallowed some of my birth control pills. Should I give ipecac?” In addition to calling emergency responders, what is the nurse’s best response? A) “Yes, give ipecac and follow the dosage directions on the bottle.” B) “Ipecac is not effective for this use so you should not give it to your child.” C) “Give the ipecac only if you are absolutely sure your child swallowed the pills.” D) “No, don’t give ipecac because it will cause your child to vomit.”

Ans: B

Feedback: Ipecac is a drug that the Food and Drug Administration tested in 2003 and found, despite its use for many years, that it was not effective in inducing vomiting in children suspected of poisoning. As a result, it is no longer used. The mother should be instructed not to give it and to call poison control to get up-to-date instructions on how to deal with this emergency. This child requires appropriate intervention regardless of whether the parent can confirm the pills were swallowed because it is better to err on the side of caution. Making a mess is not a concern.

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B) Any drug that is shipped into the United States is deemed safe to use. C) Foreign drugs may have the same name as domestic drugs but may not be the same drug. D) If you order from Canada or Mexico, the drugs are safer than from other sources because they undergo testing.

Ans: C

Feedback: The Food and Drug Administration has begun checking these drugs when they arrive in this country and have found many discrepancies between what was ordered and what is in the product, as well as problems in the storage of these products. Some foreign brand names are the same as brand names in this country but are associated with different generic drugs. Not all drugs are manufactured the same, and they are not always safe coming from another country.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 68, Consumer Awareness 26. The nurse has cared for several clients who have requested a drug they have seen advertised on television or in a magazine. The nurse recognizes that this is an increasingly common phenomenon. In response, the nurse should set what learning goal? A) Gather information on ways that pharmaceutical companies are deceptive. B) Investigate which specific advertisements are most influential. C) Learn why many clients turn to the internet for health information. D) Stay knowledgeable about current drug therapies.

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Ans: D

Feedback: As the marketing power for prescription drugs continues to grow, the health care provider must be constantly aware of what clients are seeing (or reading), what the commercials and ads are promising, and the real data behind the indications and contraindications for these “hot” drugs. There is no benefit in vilifying pharmaceutical companies as being “deceptive.” It is unrealistic and unnecessary for the nurse to be aware of specific, individual advertisements. Nurses should know why clients are seeking online advice, but this does not directly relate to the phenomenon in question.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 69, Over-the-Counter Drugs 27. A new parent states that they keep a supply of ipecac in the home in case of poisoning. What should the nurse teach the client about this drug? A) Ipecac is ineffective for its intended use and should be discarded. B) Ipecac should be kept in a locked cabinet. C) Ipecac is unregulated because it is herbal, and concentration varies widely. D) Ipecac induces vomiting but is associated with a risk of hematemesis.

Ans: A

Feedback: Ipecac, a formerly standard over-the-counter drug, was used for many years by parents to induce vomiting in children in cases of suspected poisoning or suspected drug overdose. The drug was finally tested, and in 2003, the FDA announced that it was not found to be effective for its intended use of inducing vomiting. The parent should be encouraged to discard the drug, not store it in a locked location.

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Format: Multiple Selection Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 68, Consumer Awareness 28. The nurse has seen an advertisement for a drug. The advertisement states that the drug is used for the treatment of erectile dysfunction. What other information must also be included in the advertisement? Select all that apply. A) symptoms of erectile dysfunction B) contraindications C) potential adverse effects D) precautions when taking the drug E) average cost when used as prescribed

Ans: B, C, D Feedback: If a drug advertisement states what the drug is used for, it must also state contraindications, adverse effects, and precautions. The advertisement does not have to state symptoms or cost.

Format: Multiple Choice Chapter: 6 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 68, Consumer Awareness

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29. The local news has been discussing a specific rare disorder that killed a child in the community this week, describing the earliest symptoms of the disease as including nasal congestion, ear pain, and a cough. The pediatrician’s office is receiving numerous calls asking to make appointments to rule out this rare disease. What is the nurse’s best action? A) Make copies of recent newspaper and online articles that provide parents with more details. B) Tell parents their child is experiencing the common cold and do not need to be seen. C) Direct all telephone calls to the Centers for Disease Control and Prevention to answer questions and provide details. D) Become familiar with the disorder and offer to provide parents with relevant information.

Ans: D

Feedback: The nurse needs to not only become more familiar with the disorder in the news but also needs to be prepared to teach parents about the “disease of the week” to allay fears so a handout with detailed information would allow the parents to have something to consult after leaving the provider’s office. Turning parents away without seeing their child will increase fears, and the office will lose credibility for lack of interest in their child’s well-being. Directing phone calls to the CDC is impractical and unnecessary and will not provide parents with timely essential information. Screening calls without seeing the child could be potentially very dangerous. Newspaper and online articles would not be the most robust information sources for parents.

Format: Multiple Choice Chapter: 6 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 1

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Page and Header: 68, Consumer Awareness 30. The nurse is teaching the client how to safely use the internet for health information and includes what information in the teaching plan? A) The website where information is obtained needs to be evaluated for credibility. B) Most information found on the internet is accurate. C) Information on the internet is most reliable when people give their reviews of the drug. D) Only a health care professional can tell whether a website is reliable.

Ans: A

Feedback: There are excellent sites for reliable drug information, but each site must be evaluated for credibility, and the nurse can teach the client things to look for to increase confidence in the site. However, a lot of information on the internet is not accurate; the client needs to learn how to recognize unreliable information when they come across these sites. Just because a person reviews a drug and gives it multiple stars or a thumbs up does not mean the drug is any more effective or useful in the client’s care.

Format: Multiple Choice Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 69, Over-the-Counter Drugs 31. The nurse practitioner is explaining how prescription drugs can sometimes become recategorized as over-the-counter (OTC) drugs. What factor would prevent a prescription drug from being made available over the counter? A) Most clients cannot reliably self-diagnose the condition the drug is intended to treat. B) The drug may mask signs and symptoms of an underlying health problem. C) The drug would cause toxic effects if not taken as directed.

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D) A pharmaceutical company still holds a patent on the drug.

Ans: A

Feedback: If a diagnosis requires medical intervention, such as hyperlipidemia, which can only be diagnosed through laboratory studies, there is no point in making the drug an OTC medication. Most, if not all, OTC drugs have the capacity to mask signs and symptoms of an underlying disease so this is not a factor in deciding if a drug can be sold OTC. All drugs have the potential for toxic effects if not taken as directed, and virtually, all drugs have the potential for adverse effects. OTC drugs can be protected by patent in the same way as prescription drugs.

Format: Multiple Selection Chapter: 6 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3 Page and Header: 70, Alternative Therapies and Herbal Medicine; 73, Drug Misuse and the Opioid Crisis 32. The nurse should ask what specific questions when collecting a client’s medication history? Select all that apply. A) “Do you take any over-the-counter medications?” B) “Do you take any herbal supplements?” C) “Do you ever use any recreational drugs?” D) “Do you take any natural supplements or vitamins?” E) “What unusual therapies do you take?”

Ans: A, B, C, D

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Feedback: The nurse needs to specifically question the client’s use of over-the-counter drugs, herbal supplements, natural supplements, recreational drugs, and vitamins. Use of terms like “unusual therapies” is too vague and may not elicit the kind of information needed.

Test Generator Questions, Chapter 7, Introduction to Cell Physiology Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 82, The Cell 1. The nurse is caring for a client with a chromosomal disorder. What part of the cell is primarily involved in this client’s disorder? A) cytoplasm B) membrane C) nucleus D) organelles

Ans: C

Feedback: The nucleus of a cell contains all of the genetic material that is necessary for cell reproduction. The nucleus also contains genes or sequences of deoxyribonucleic acid (DNA). Genes are responsible for the formation of messenger ribonucleic acid (mRNA) and transcription RNA, which are involved in production of proteins unique to the cells. This is the area where chromosomal disorders originate. The cell cytoplasm lies within the cell membrane and is the site of activities of cellular metabolism and special cellular functions. The organelles are contained within the cytoplasm and are structures with specific functions. They include the mitochondria, endoplasmic reticulum, free ribosomes, Golgi apparatus, and lysosomes. The membrane is a thin barrier, which

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separates the intracellular fluid from the extracellular fluid and is essential for cellular integrity; it also maintains cell homeostasis.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 85, Cell Properties 2. Hormones have formed within a client’s cell and moved across the cell membrane. What process has taken place? A) endocytosis B) exocytosis C) phagocytosis D) pinocytosis

Ans: B

Feedback: Exocytosis is the movement of substances such as waste products, hormones, and neurotransmitters out of the cell. Pinocytosis is the ingestion of liquid into a cell, commonly called “cell drinking.” Receptor-mediated endocytosis uses receptors to incorporate material into the cell. Phagocytosis involves the destruction of engulfed proteins or bacteria.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 4 Page and Header: 85, Cell Properties 3. Body substances have moved freely in and out of a client’s cells by diffusion. What substance is most likely to move by this means? A) carbon dioxide B) pancreatic amylase C) insulin D) albumin

Ans: A

Feedback: Substances that move into and out of a cell by diffusion include carbon dioxide, oxygen, and water. These substances move through channels or pores in the cell membrane through movement from a region of higher concentration to a region of lower concentration. Hormones (insulin), enzymes (pancreatic amylase), and proteins (albumin) are considered carriers. If a substance cannot move freely on its own, it may attach itself to another carrier to be diffused.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 87, Cell Cycle 4. A client with metastatic lung cancer is receiving chemotherapy. In what phase of the cell cycle would this treatment be least effective? A) G0 phase B) G1 phase C) G2 phase D) S phase

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Ans: A

Feedback: During the G0 phase, the cell is stable. Cells in this phase can interfere with cancer chemotherapy because these drugs usually work on actively dividing cells, leaving resting cells mostly untouched. When the resting cells are stimulated to become active and regenerate, the cancer can return. This is the reason that cancer chemotherapy regimens are complicated and extended over a period of time. In the G1 phase, a cell is stimulated to emerge from its resting phase. During this time, the cell synthesizes the substances needed for DNA formation. The S phase involves the actual synthesis of DNA, and during the G2 phase, the cell produces all the substances that are required for the manufacture of the mitotic spindles.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 82, The Cell 5. A client’s abnormal immune response has been attributed to disruptions in cell histocompatibility. What physiologic process is defective in this client? A) reproduction of cells when other cells die B) recognition of cells as self-cells that belong in the body C) production of antibodies to viral invaders D) antigen stimulation of white blood cell production Ans: B

Feedback: The histocompatibility antigens are proteins that are seen on the top of the cell membrane. T cells use these antigens as the identifying proteins that identify a cell as a self-cell. If these antigens are not present on a cell membrane, the T cells may

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destroy that cell, determining that it is foreign. The histocompatibility antigens are not involved in reproduction. They do not produce antibodies nor do they stimulate white blood cell production.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 82, The Cell 6. The nurse is debriding a client’s pressure ulcer to remove the dead cells. What is the physiological rationale for the nurse’s action? A) The lysosomes released by the dead cells in the area continue to kill other cells, destroying more tissue. B) The dead cells no longer contain histocompatible antigens causing a greater inflammatory response. C) Removing dead tissue allows oxygen to enter the damaged cells to regenerate them and to promote healing. D) The presence of dead cells near living cells inhibits the cell cycle.

Ans: A

Feedback: When a cell dies, its cell membrane ruptures and the lysosomes release lysozymes, which dissolve protein. When many cells die, lysozymes accumulate and dissolve the proteins that the dead cells leave behind, but the lysozymes also destroy the cell membrane of healthy cells in the area. Those cells then die, releasing lysozymes, which destroy more cells, and a vicious cycle occurs. A decubitus ulcer is an area of many dead cells, which are killing healthy cells. The area needs to be scraped clean to remove the dead cells so that the lysozymes will stop destroying healthy cells and allow oxygen to return to the area through the capillary bed, which allows healing to occur.

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Many treatments exist for decubitus ulcers, all of which depend on the return of blood flow to the area and removal of the dead tissue. The presence of dead cells has no direct effect on the cell cycle.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 85, Cell Properties 7. A client is hypovolemic from vomiting and diarrhea. The nurse recognizes that the client’s blood is likely hypertonic as a result of fluid loss. What effect does the nurse expect this will have on the red blood cells? A) They will swell and eventually rupture. B) Red blood cells will migrate to the bone narrow. C) The cells will shrink and shrivel. D) The red blood cells will precipitate out of circulation.

Ans: C

Feedback: A hypertonic solution will draw the water out of the red blood cell, causing it to shrink and shrivel, decreasing the oxygen-carrying ability of the red blood cell. A hypotonic solution would result in water moving into the red blood cell, causing it to swell and burst. Red blood cells will not migrate back to the bone marrow or precipitate out of circulation.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 3 or 5 Page and Header: 81, Introduction 8. A client diagnosed with ovarian cancer is being treated with carboplatin, a chemotherapeutic agent. The nurse recognizes that this drug interferes with cellular physiology resulting in what action? A) cellular death B) diffusion C) endocytosis D) homeostasis

Ans: A

Feedback: Drugs may alter the cell membrane, causing the cell to rupture and die, or they may deprive the cell of certain nutrients, altering the proteins that the cell produces. This could interfere with normal cell functioning and cell division. Diffusion is the movement of a substance from a region of higher concentration to a region of lower concentration. Endocytosis involves gathering of material into a cell. Homeostasis refers to keeping the cytoplasm stable within the cell membrane. Diffusion, endocytosis, and homeostasis are not the result of chemotherapeutic agents but may be impacted by the agent.

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9. The nurse is caring for a client who has a disorder that primarily affects the rough endoplasmic reticulum (ER). This client will have disruptions involving what normal process? A) producing proteins B) combining protein with other components of the cytoplasm C) exporting protein from the cell D) destroying ribosomes

Ans: A

Feedback: Many granules that contain enzymes and ribosomes, which produce protein, are scattered over the surface of the rough endoplasmic reticulum. Production of proteins, phospholipids, and cholesterol takes place in the rough endoplasmic reticulum. The rough ER segregates (rather than combines) these proteins from other components of the cytoplasm and modifies their structure for a specific function. Rough ER does not transport anything through the cell membrane. Rough ER is studded with ribosomes; it does not destroy them.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 82, The Cell 10. A client’s congenital chromosomal disorder affects the physiology of the Golgi apparatus? What possible consequence of this disorder should the nurse identify? A) mitochondrial death B) inadequate preparation of hormones to be secreted from the cell C) impaired production of new red blood cells D) lysis of the cell membrane or inhibited active diffusion

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Ans: B

Feedback: The Golgi apparatus is a series of flattened sacs that may be part of the endoplasmic reticulum. These structures prepare hormones or other substances for secretion by processing them and packaging them in vesicles to be moved to the cell membrane for excretion from the cell. Golgi bodies do not directly produce red blood cells. Mitochondrial death or cell membrane lysis does not result from disruptions to the Golgi apparatus.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 82, The Cell 11. Cytological testing reveals that a client has impaired mitochondrial function. This client is likely to have a deficiency of what substance? A) deoxyribonucleic acid (DNA) B) red blood cells C) lactic acid D) adenosine triphosphate (ATP)

Ans: D

Feedback: Mitochondria are rod-shaped “power plants” within each cell that produce energy in the form of ATP, which allows the cell to function. Red blood cells and DNA are not formed in the mitochondria. If oxygen is not available, lactic acid builds up as a byproduct of cellular respiration. Lactic acid leaves the cell and is transported to the liver for conversion to glycogen and carbon dioxide.

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Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 2 Page and Header: 82, The Cell 12. The nurse is teaching a client about the fact that components of cells are constantly being worn out and dying. What organelle digests worn or damaged sections of a cell when the cell dies? A) Golgi apparatus B) lysosomes C) endoplasmic reticulum D) mitochondria

Ans: B

Feedback: Lysosomes are membrane-covered organelles that contain specific digestive enzymes that can break down proteins, nucleic acids, carbohydrates, and lipids. They are responsible for digesting worn or damaged sections of a cell when the membrane ruptures and the cell dies. The Golgi apparatus prepares substances for secretion by processing and packaging them in vehicles to move through the cell membrane. The endoplasmic reticulum provides a large surface for chemical reactions within the cell. Mitochondria are the power plants of the cell.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand

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Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 82, The Cell 13. The nurse is teaching a client about the two types of ribosomes that exist within a cell. Ribosomes that are not bound to the endoplasmic reticulum exist throughout the cytoplasm of the cell and produce proteins with what purpose? A) bind themselves to the Golgi apparatus B) bind to produce the endoplasmic reticulum C) denature unnecessary enzymes within the cell D) contribute to the structure of the cell

Ans: D

Feedback: Ribosomes that are not bound to the surface of the endoplasmic reticulum exist throughout the cytoplasm. These free-floating ribosomes produce proteins that are important to the structure of the cell and some of the enzymes that are necessary for cellular activity. Free-floating ribosomes do not bind themselves to the Golgi apparatus, produce endoplasmic reticulum, or denature any part of the cell or its contents.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 85, Cell Properties 14. The nurse is describing the function of the sodium–potassium pump when explaining the large difference in intracellular and extracellular serum levels of these electrolytes. What process is the nurse primarily referring to? A) passive transport B) neutral transport

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C) cotransport D) active transport

Ans: D

Feedback: Active transport is what happens when cells use energy to move ions against an electrical or chemical gradient. Diffusion is a type of passive transport. There is no such thing as neutral transport. Cotransport is when the sodium ion and the solute are transported in the same direction.

Format: Multiple Selection Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 82, The Cell 15. The nurse recognizes which parts of the cell as comprising the main structural and functional parts? Select all that apply. A) the nucleus B) the cytoplasm C) the cell membrane D) the Golgi apparatus E) Lysosomes

Ans: A, B, C

Feedback: The cell is composed of a nucleus, which contains genetic material and controls the production of proteins by the cell; a cell membrane, which separates the inside of the cell from the outside environment; and cytoplasm, which contains various

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organelles important to cell function. The Golgi apparatus and lysosomes are significant units within the cytoplasm but are not main parts of the cell.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 82, The Cell 16. The nurse is reviewing the function of receptor sites in cell physiology. What is the role of receptor sites? A) maintaining contact with outside proteins to prevent lysis of the cell wall B) maintaining contact with inside proteins to prevent lysis of the cell wall C) reacting with specific chemicals outside the cell to change the function of that chemical D) reacting with specific chemicals outside the cell to stimulate a reaction within the cell

Ans: D Feedback: Embedded in the cell membrane are a series of peripheral proteins with several functions. One type of protein located on the cell membrane is known as a receptor site. This protein reacts with specific chemicals outside the cell to stimulate a reaction within a cell. Receptor sites do not prevent lysis of the cell wall nor do they stimulate a reaction outside of the cell.

Format: Multiple Selection Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 3 Page and Header: 82, The Cell 17. Proteins within the cell wall allow the passage of several substances into and out of the cell. What substances do these include? Select all that apply. A) calcium B) phosphorous C) magnesium D) manganese E) chloride

Ans: A, E

Feedback: Channels or pores within the cell membrane are made by proteins in the cell wall that allow the passage of small substances in or out of the cell. Specific channels have been identified for sodium, potassium, calcium, chloride, bicarbonate, and water; other channels may also exist. Some drugs are designed to affect certain channels specifically. For example, calcium channel blockers prevent the movement of calcium into a cell through calcium channels. Phosphorus, magnesium, and manganese are not known to have their own channels at this time.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 87, Cell Cycle 18. A cell has produced all the substances necessary for the formation of a new cell. What phase of the cell cycle will occur next? A) G0 phase

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B) M phase C) S phase D) G2 phase

Ans: B

Feedback: After the cell has produced all substances necessary for formation of a new cell, or daughter cell, it undergoes cell division. This occurs during the M phase of the cell cycle. During this phase, the cell splits to form two identical daughter cells, a process called mitosis. The S phase involves the actual synthesis of DNA. In the G2 phase, the cell produces all the substances required for manufacture of the mitotic spindles. The G0 phase is the resting phase.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 87, Cell Cycle 19. During the cell cycle, the cell is stimulated to emerge from its resting phase and enter what stage? A) M phase B) S phase C) G1 phase D) G2 phase

Ans: C

Feedback: When a cell is stimulated to emerge from its resting phase, it enters what is called the G1 phase, which lasts from the time of stimulation from the resting phase until the formation of deoxyribonucleic acid (DNA). During this period, the cell is actively

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collecting materials to produce the building blocks for DNA. The S phase involves the actual synthesis of DNA. In the G2 phase, the cell produces all the substances needed to replicate itself, and then in the M phase, it undergoes cell division.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 85, Cell Properties 20. The nurse is explaining the fact that glucose must sometimes attach to another molecule in order to move into a cell. The nurse is describing what process? A) active transport B) osmosis C) passive transport D) facilitated diffusion

Ans: D

Feedback: Sometimes a substance cannot move freely on its own in or out of a cell. Such a substance may attach to another kind of molecule, called a carrier, to be diffused. This form of diffusion, known as facilitated diffusion, does not require energy, only the presence of the carrier. Active transport requires energy to move the substance against the concentration gradient. Osmosis is a special form of diffusion where water moves across a semipermeable membrane from an area low in solutes to one that is higher in solutes to dilute solutes. Passive transport does not require energy to move solutions across a semipermeable membrane and includes diffusion, osmosis, and facilitated diffusion.

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Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 87, Cell Cycle 21. A cell is currently synthesizing deoxyribonucleic acid (DNA). What phase of cell division is taking place in this cell? A) S phase B) G0 phase C) M phase D) G2 phase Ans: A

Feedback: The next phase, called the S phase, involves the actual synthesis of DNA, which is an energy-consuming activity. The cell remains in this phase until the amount of cellular DNA has doubled. The G0 phase is considered the resting phase of the cell cycle. The M phase is when cell replication occurs. The G2 phase is when the cell produces all substances it needs to replicate.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 87, Cell Cycle 22. The G1 phase of a client’s cell cycle has been disrupted. What physiologic process will be impaired?

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A) cell stability or resting B) synthesis of substances for DNA formation C) cell division D) production and strengthening of mitotic spindles

Ans: B

Feedback: The G1 phase lasts from the time of stimulation from the resting phase until the formation of DNA. During this period, the cell synthesizes substances needed for DNA formation. Mitotic spindles are produced in the S phase; rest is accomplished in the G0 phase; and cell division is in the M phase.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 82, The Cell 23. The nurse is explaining the characteristics of an appropriate donor to a client with end-stage liver disease who requires a liver transplant. What topic should the nurse describe? A) histocompatibility antigens B) lipoproteins C) active transport D) receptor sites

Ans: A

Feedback: When an organ is transplanted from one person to another, a great effort is made to match as many histocompatibility antigens as possible to reduce the chance

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that the “new” body will reject the transplanted organ. The body’s immune system recognizes the human leukocyte antigens (HLA) proteins and acts to protect self-cells and to destroy non–self-cells. Lipoproteins, receptor sites, and active transport are not directly relevant to this process.

Format: Multiple Selection Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 82, The Cell; 85, Cell Properties 24. The cell membrane, an integral part of the cell, is essential for what? Select all that apply. A) cell movement B) cellular integrity C) cell survival D) cell homeostasis E) cell maturation

Ans: B, C, D

Feedback: The membrane is essential for cellular integrity and is equipped with many mechanisms for maintaining cell homeostasis. The cell membrane does not have a direct effect on cell movement or maturation.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 87, Cell Cycle 25. The nurse has administered doxorubicin, a chemotherapeutic, to a client diagnosed with metastatic breast cancer. The nurse should be aware that this medication will have the least effect on cells during what phase of the cell cycle? A) G0 phase B) G1 phase C) S phase D) G2 phase Ans: A

Feedback: During the G0 phase, or resting phase, the cell is stable. It is not making any proteins associated with cell division and is basically dormant in terms of reproduction. These cells are functioning to do whatever they are supposed to do. Most drugs, particularly chemotherapy for cancer, work on active cells so cells that are resting are less susceptible to chemical action. The other options are active phases when drugs will be most effective.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Page and Header: 85, Cell Properties 26. The nurse is caring for a client diagnosed with acute renal failure with hyperkalemia. The health care provider prescribes insulin that causes potassium to return to the intracellular space, thereby lowering serum potassium levels. The nurse should recognize the therapeutic benefits of what process?

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A) passive transport B) active transport C) osmosis D) diffusion

Ans: B

Feedback: Moving potassium back into the cell, an area with a higher concentration gradient than the bloodstream, requires energy. Insulin helps to activate the sodium– potassium pump. Passive transport is a means of moving substances in and out of the cell without the use of energy. Potassium levels are elevated and will not diffuse into the cell independently because potassium levels are higher inside the cell than outside and require energy to cross the concentration gradient. Osmosis involves diffusion of water.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 85, Cell Properties 27. The nurse is caring for a client experiencing edema caused by escape of fluid from the intravascular compartment to the extracellular space. What type of IV solution should the nurse administer to draw the fluid back into the intravascular compartment? A) isotonic solution B) hypertonic solution C) hypotonic solution D) osmotic solution

Ans: B

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Feedback: Hypertonic solutions are those with a higher concentration of solutes than human plasma. They draw water from cells, which would help to draw fluid back into the intravascular space. Hypotonic solutions are fluids that contain a lower concentration of solutes than human plasma, which causes water to be pushed into the cells. Isotonic fluids contain the same concentration of solutes as human plasma and will not cause fluids to shift from one compartment to another. Osmotic solution is a distracter. Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 85, Cell Properties 28. The cytoplasm within a cell is currently stable within the cell membrane. This cell is in what state? A) homeostasis B) meiosis C) excitability D) mitosis

Ans: A

Feedback: The main goal of a cell is to maintain homeostasis, which means keeping the cytoplasm stable within the cell membrane. This state is not described as meiosis, mitosis, or excitability.

Format: Multiple Choice Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 2 Page and Header: 82, The Cell 29. The client has been diagnosed with multiple sclerosis, a disease that reduces the amount of available adenosine triphosphate (ATP) in the body. The nurse recognizes that this reduction in ATP is caused by the impact of the disease on what part of the cell? A) cell neuron B) endoplasmic reticulum C) Golgi bodies D) mitochondria

Ans: D

Feedback: The mitochondria are rod-shaped “power plants” within each cell that produce energy in the form of ATP, which allows the cell to function. Inadequate production of ATP would indicate damage to the functioning of the mitochondria. The neuron, endoplasmic reticulum, and Golgi bodies do not produce ATP.

Format: Multiple Selection Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 81, Introduction 30. Chemotherapeutic medications have the capacity to destroy which organisms with introduced appropriately into the human body? Select all that apply. A) bacteria B) viruses C) parasites D) neoplasms

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E) fungi

Ans: A, B, C, D, E Feedback: Chemotherapeutic drugs are used to destroy both organisms that invade the body (e.g., bacteria, viruses, parasites, protozoa, fungi) and abnormal cells within the body (e.g., neoplasms, cancers).

Format: Multiple Selection Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 87, Cell Cycle 31. What information should the nurse present when discussing aspects of the cell? Select all that apply. A) Mitosis is a reproductive process. B) Cell count is determined by the cell’s genetic makeup. C) Most cells reproduce at a standardized rate. D) Production of new red blood cells is influenced by erythropoietin. E) The life cycle of all cells is similar.

Ans: A, B, D, E

Feedback: Many cells have the ability to reproduce themselves through the process of mitosis. The genetic makeup of a particular cell determines the rate at which that cell can multiply. Some cells reproduce very quickly (e.g., the cells lining the gastrointestinal tract have a generation time of 72 hours), and some reproduce very slowly (e.g., the cells found in breast tissue have a generation time of a few months). In some cases, certain factors influence cell reproduction. Erythropoietin, a hormone produced by the kidney, can stimulate the production of new red blood cells. Active leukocytes release

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chemicals that stimulate the production of white blood cells when the body needs new ones. Regardless of the rate of reproduction, each cell has approximately the same life cycle.

Format: Multiple Selection Chapter: 7 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 82, The Cell 32. Which organelles are found within the cell’s cytoplasm? Select all that apply. A) mitochondria B) free ribosomes C) Golgi apparatus D) lipoproteins E) endoplasmic reticulum

Ans: A, B, C, E

Feedback: The cell cytoplasm lies within the cell membrane outside the nucleus and is the site of cellular metabolism activities and special cellular functions. The cytoplasm contains many organelles, structures with specific functions such as producing proteins and energy. The organelles within the cytoplasm include the mitochondria, the endoplasmic reticulum, free ribosomes, the Golgi apparatus, and the lysosomes. On the other hand, the cell membrane is a lipoprotein structure, meaning that it is mainly composed of proteins and lipids—phospholipids, glycolipids, and cholesterol.

Test Generator Questions, Chapter 8, Anti-Infective Agents Format: Multiple Choice

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Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 91, Therapeutic Actions 1. The nurse is describing to a client how the client’s newly prescribed anti-infective medication produces a therapeutic effect. What explanation should the nurse provide the client? A) Anti-infectives mobilize the client’s own immune system against a microorganism. B) Anti-infectives increase resilience of human body cells. C) The goal of treatment is to identify drugs that are selectively toxic to human cells. D) Many anti-infectives interfere with normal functioning of the target organism.

Ans: D

Feedback: The goal of anti-infectives is to interfere with the normal function of the invading organism to prevent it from reproducing and to cause cell death without affecting host cells. Each class of anti-infectives works in a different way, but all have the same goal. Anti-infectives do not mobilize the human immune response or increase resilience. The term selective toxicity refers to the ability to affect certain proteins or enzyme systems that are used by infecting organisms, but not by human cells.

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2. The nurse is reviewing anti-infective medications prior to caring for a client who is diagnosed with sepsis. What statements are accurate descriptions of anti-infective therapy? Select all that apply. A) Some anti-infectives interfere with biosynthesis of the pathogen’s cell wall. B) Some anti-infectives prevent the cells of the organism from using essential substances. C) Many anti-infectives interfere with the steps involved in protein synthesis. D) Some anti-infectives interfere with ribonucleic acid (RNA) synthesis in the cell leading to cell death. E) Some anti-infectives work indirectly, by focusing and strengthening the body’s immune function.

Ans: A, B, C

Feedback: Some anti-infectives interfere with deoxyribonucleic acid (DNA) synthesis, not RNA synthesis, in the cell, leading to inability to divide and causing cell death. The fluoroquinolones work in this way. The other three options are correct and would not indicate the need for further study time. Penicillins interfere with biosynthesis of the cell wall, sulfonamides prevent organisms from using substances essential to their growth and development, whereas aminoglycosides, macrolides, and chloramphenicol interfere with protein synthesis. Anti-infectives do not directly enhance immune function.

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3. The nurse administers a drug to treat Chlamydia trachomatis. The nurse is aware that this drug has no effect on any other bacteria. How should the nurse describe this characteristic of the drug? A) The drug is bactericidal. B) The drug has a narrow spectrum. C) The drug has prophylactic qualities. D) The drug is bacteriostatic.

Ans: B

Feedback: Without knowing the name of the antibiotic and how it works to treat Chlamydia trachomatis, the only thing that can be said is that it is a narrow-spectrum anti-infective because it only treats one specific organism. Broad-spectrum antiinfectives treat multiple organisms. The name of the drug and how it works would need to be known to determine whether it is bactericidal or bacteriostatic.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 91, Therapeutic Actions; 94, Box 8.3 4. The nurse has provided client teaching for a client who will be discharged to home on an anti-infective medication. What statement made by the client indicates the nurse needs to provide additional teaching concerning the use of anti-infectives? A) “Antibiotics will not help me when I have a viral infection.” B) “A bacterial culture will usually be done before I’m prescribed antibiotics.” C) “It’s not unusual to develop diarrhea as a result of taking an antibiotic.” D) “I will stop taking the antibiotic once my symptoms have resolved.”

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Ans: D

Feedback: Compliance with anti-infective therapy is a concern. Patients tend to stop taking the drugs when they begin to “feel better.” A nurse should instruct the client to take the entire course of prescribed drug to ensure a sufficient period to rid the body of pathogens and to help prevent the development of resistance. Antibiotics are not prescribed for viral infections. It is important that cultures be performed before antibiotics are prescribed to determine what organism is causing the infection so that the correct drug is prescribed. Diarrhea is the most common adverse effect from antiinfectives.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 91, Therapeutic Actions; 94, Box 8.3 5. The nurse is providing health education to a client with an infection who lives in the community. What characteristic of the client’s anti-infective regimen will best prevent the development of resistant strains of microbes? A) proactively addressing the possibility of adverse effects B) performing culture and sensitivity testing after the completion of treatment C) ensuring that the duration of drug use is appropriate D) maximizing the frequency of drug ingestion

Ans: C

Feedback: Exposure of pathogens to an antimicrobial agent without cellular death leads to the development of resistance so it is important to limit the use of these agents to treat pathogens with a known sensitivity to the drug being used. The duration of drug

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use is critical to ensure that microbes are completely eliminated and not given the chance to grow and develop resistant strains. Adverse effects must be addressed, but this is not directly related to the development of resistance. Dosing frequency must be determined with the goal of enhancing the therapeutic action, but excessive frequency can cause problems with the client’s adherence. Follow-up testing is not a major component of preventing resistance.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 4 Page and Header: 91, Therapeutic Actions; 94, Box 8.3 6. A nurse practitioner is teaching a group of nurses about actions that have the potential to prevent antibiotic resistance. What teaching point should the nurse practitioner include? A) Antibiotics should be taken promptly to treat colds and other viral infections before the invading organism has a chance to multiply. B) Antibiotic dosage should be reduced and used for shorter periods of time to reduce unnecessary exposure to the drug. C) Standing prescriptions for antibiotics should be available to clients so they can be filled as soon as clients suspect they have an infection. D) It is very important to take the full course of an antibiotic as prescribed and not save remaining drugs for future infections.

Ans: D

Feedback: Teaching clients to take the full course of their antibiotic as prescribed can help to decrease the number of drug-resistant strains. Antibiotics should only be used to treat bacterial infections that have been cultured to identify the antibiotic sensitivity, and

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then, clients should be instructed to use the antibiotic for the prescribed course, which will help to eliminate drug-resistant strains. Reducing dosage and time intervals increases the chance for drug resistance because anti-infectives are most effective when taken exactly as indicated.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 94, Using Anti-Infective Agents 7. Which client is receiving prophylactic anti-infectives? A) a client with metastatic lung cancer who will soon begin chemotherapy B) a client with human immunodeficiency syndrome who begins antiretroviral therapy C) a client who is prescribed a 3-day course of antibiotics prior to dental surgery D) a client who has been admitted for the treatment of an infected surgical incision

Ans: C

Feedback: In a situation where an infection is likely to occur, antibiotics can be used to prevent it. Giving antibiotics before surgery is an example of prophylaxis. Chemotherapy is the use of drugs to destroy abnormal cells, usually cancer cells; this is not prophylactic. Antiretroviral therapy and treatment of an active infection are not prophylactic.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 96, Adverse Reactions to Anti-Infective Therapy; 96, Box 8.5 8. A client is receiving meropenem. When monitoring the client for a drug-related reaction, the nurse should prioritize what assessment? A) bowel pattern B) AST, ALT, and bilirubin levels C) urine output D) orientation and level of consciousness

Ans: A

Feedback: This drug has been associated with potentially fatal pseudomembranous colitis, which affects the gastrointestinal tract. This drug is not particularly associated with liver, kidney, or neurologic toxicity. Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 91, Therapeutic Actions 9. The nurse is caring for a client receiving penicillin for the treatment of syphilis. When teaching the client about the therapeutic effect of this medication, the nurse should describe what mechanism? A) physical destruction of DNA B) inhibition of protein synthesis C) inhibition of cell wall biosynthesis D) bacterial mutation

Ans: C

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Feedback: Some anti-infectives interfere with biosynthesis of the bacterial cell wall. Because bacterial cells have a slightly different composition than human cells, this is an effective way to destroy the bacteria without interfering with the host. The penicillins work in this way. They do not inhibit protein synthesis, cause mutations, or destroy DNA.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 4 Page and Header: 94, Using Anti-Infective Agents 10. A nurse collects a culture sample from a client’s infected wound bed. Laboratory testing of this sample will allow the health care team to focus on what? A) identifying the specific organism causing the infection B) approximating the client’s risk for antibiotic resistance C) identifying individualized client factors contributing to infection D) assessing the components of the client’s normal flora

Ans: A

Feedback: A culture is collected to identify the causative organism of an infection. It can help with determining the site of infection in some cases if the infection is limited only to the site where the culture is collected. It does not individualize client factors contributing to infection or focus on the client’s normal flora. Results of culture testing do not directly indicate the client’s risk for experiencing antibiotic resistance.

Format: Multiple Selection Chapter: 8

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4, 5 Page and Header: 91, Therapeutic Actions; 94, Box 8.3 11. A nurse practitioner provides primary care in a rural setting. The nurse should perform what actions in order to minimize the emergence of drug-resistant microbials? Select all that apply. A) Avoid the use of broad-spectrum antibacterial drugs when treating trivial or viral infections. B) Use narrow-spectrum agents if they are thought to be effective. C) Do not use vancomycin. D) Start antibiotics promptly before the culture and sensitivity report returns. E) Administer the highest tolerated dosage.

Ans: A, B, C

Feedback: Exposure to an antimicrobial agent leads to the development of resistance, so it is important to limit the use of antimicrobial agents to the treatment of specific pathogens known to be sensitive to the drug being used. Drug dosage is important in preventing the development of resistance. Doses should be high enough and the duration of drug therapy should be long enough to eradicate even slightly resistant microorganisms, but the prescriber does not aim for the highest possible tolerated dose. It is best to wait until cultures return before initiating antibiotics when possible, but clients with severe infections may be started on broad-spectrum antibiotics while waiting for culture results.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 91, Therapeutic Actions 12. The home care nurse is taking care of a client on IV vancomycin for cellulitis of the left calf. The client’s lack of response to treatment suggests possible resistance. What process may have caused this phenomenon? A) Microorganisms may have altered the blood supply to the infected region. B) Microorganisms may have stopped healthy somatic cells from reproducing. C) Microorganisms may have produced a chemical that is an antagonist to the drug. D) Microorganisms may have changed their cell membrane to mimic that of the drug.

Ans: C

Feedback: Microorganisms develop resistance in a number of ways, including the following: changing cellular permeability to prevent the drug from entering the cell or altering transport systems to exclude the drug from active transport into the cell; altering binding sites on the membranes or ribosomes, which then no longer accept the drug; and producing a chemical that acts as an antagonist to the drug. Microorganisms do not alter the blood supply to the infection or stop a cell from reproducing. Antiinfectives are chemicals; they do not have cell membranes.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 96, Adverse Reactions to Anti-Infective Therapy 13. The nurse is caring for a diverse group of client on a hospital medical unit. What client is most likely to experiencing a superinfection?

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A) a client who has acute kidney injury following Escherichia coli infection B) a client who is recovering from viral meningitis C) a client who has been admitted for the treatment of a dehisced and infected surgical incision D) an older adult client with Clostridium difficile–associated diarrhea

Ans: D Feedback: In recent years, the emergence of Clostridium difficile infections has been associated with the use of specific antibiotics. An E. coli infection, meningitis, and an infected abdominal incision are not as likely to be the consequence of a superinfection.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 94, Using Anti-Infective Agents 14. A client experiencing a urinary tract infection has been prescribed a medication that is a combination of sulfamethoxazole and trimethoprim. What is the most likely rationale for the use of a combination antibiotic? A) The drugs’ combined effect exceeds the sum of their individual effects. B) It is not possible to culture the microorganisms most likely responsible for the infection. C) One of the antibiotics exists solely to facilitate absorption of the other. D) One antibiotic is narrow spectrum and one is broad spectrum.

Ans: A

Feedback: Some drugs are synergistic, which means that they are more powerful when given in combination. Combination drugs do not normally exist to promote absorption,

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and they are not always a combination of narrow and broad spectrum. An inability to perform culture and sensitivity testing would not directly require combination therapy.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 91, Therapeutic Actions 15. A client with an infection has been prescribed metronidazole, a bactericidal antibiotic. What should the nurse determine is the therapeutic effect of the medication? A) death of the microbial cells B) slowing of bacterial deoxyribonucleic acid (DNA) replication C) mutation of bacterial DNA D) prompt removal of dead tissue

Ans: A

Feedback: Some anti-infectives are so active against the infective microorganisms that they actually cause the death of the cells they affect. These drugs are said to be bactericidal. Bactericidal agents do not slow DNA replication or cause mutations. Removal of dead tissue is not relevant to anti-infective therapy.

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Objective: 4 Page and Header: 91, Therapeutic Actions; 94, Box 8.3 16. The nurse is caring for a child who weighs 30 kg. The health care provider orders gentamicin t.i.d. The recommended dosage range is 6 to 7.5 mg/kg/d. What should the nurse explain is the importance of giving a dosage within this recommended range? Select all that apply. A) avoiding toxic effects B) protecting other clients C) reducing the risk of drug-resistant organisms D) eradicating the bacteria promptly E) promoting lactic acid clearance

Ans: A, B, C, D

Feedback: By administering the correct dosage, you avoid overdosage and reduce the risk of toxic effects. The correct dosage reduces the risk of creating drug-resistant organisms; it also protects both the client and the other clients who might be susceptible to the drug-resistant organisms as well. The proper dosage is needed to eradicate the bacteria. Lactic acid removal is not related to the proper dosage.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 90, Introduction; 91, Box 8.1 17. The nurse is administering an anti-infective to a pediatric client. What assessment related to adverse effects in this client should the nurse prioritize? A) skin integrity and peripheral tissue perfusion B) hydration and nutritional status

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C) liver and pancreatic function D) rest and sleep status

Ans: B

Feedback: Because children can have increased susceptibility to the gastrointestinal and nervous system effects of anti-infectives, monitor hydration and nutritional status carefully. Patients should be encouraged to drink fluids. Integumentary, peripheral vascular, hepatic, and pancreatic function are not at greater risk in children. Rest and sleep status are important but are not usually impacted directly by anti-infectives.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 94, Using Anti-Infective Agents 18. A client who has returned from traveling overseas is suspected of having a parasitic infection. What action should the nurse anticipate performing? A) Obtain blood cultures. B) Administer prophylactic antibiotics as prescribed. C) Collect a stool sample. D) Administer an antiviral medication as prescribed.

Ans: C

Feedback: When investigators search for parasitic sources of infection, the stool is examined for ova and parasites. Blood is unlikely to reflect signs of parasitic infection. Antivirals or antibiotics would not be prescribed before laboratory results were reviewed.

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Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 96, Adverse Reactions to Anti-Infective Therapy 19. The nurse is caring for a client receiving IV aminoglycosides for an intractable leg infection. What assessment should the nurse prioritize? A) assessment of visual acuity B) liver enzyme levels and fluid balance C) serum glucose levels D) urine output and creatinine clearance levels

Ans: D

Feedback: When clients are taking aminoglycosides, it is important they be monitored closely for any sign of renal dysfunction. Aminoglycosides do not generally cause visual disturbances, liver dysfunction, or altered serum glucose levels.

Format: Multiple Selection Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 96, Adverse Reactions to Anti-Infective Therapy

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20. The nurse collects the past medical history of a client new to the clinic. The client reports an allergy to penicillin. What questions about the allergy should the nurse ask the client? Select all that apply. A) “What signs and symptoms were displayed with the reaction?” B) “Were you offered alternative medications?” C) “Do others in your family have similar allergies?” D) “How many doses were administered before the reaction occurred?” E) “Had the medication ever been prescribed before the time when the reaction occurred?”

Ans: A, D, E

Feedback: It is important to determine what the allergic reaction was and when the client experienced it (e.g., after first use of drug, after years of use). If they have been prescribed this medication before with no reaction and then had a reaction the next time it was prescribed, this would be important information to know. Some clients report having a drug allergy, but closer investigation indicates that their reaction actually constituted an anticipated effect or a known adverse effect to the drug. It would not necessarily be important to find out family allergy history or alternatives offered to the client in the past.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 94, Using Anti-Infective Agents 21. A client presents to the clinic to talk with the nurse about planned overseas travel. The client tells the nurse that the plans include travel to an area of the world where malaria is common. What should the nurse teach the client?

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A) “We can ask the health care provider to give you some anti-infectives in case you get malaria.” B) “We can ask the health care provider for some anti-infectives for you to take to prevent malaria.” C) “Don’t worry, if you get malaria it is readily treatable where you are going.” D) “Unfortunately, malaria is resistant to any currently available treatment options.”

Ans: B

Feedback: Some anti-infectives are used as a means of prophylaxis when clients expect to be in situations that will expose them to a known pathogen, such as travel to an area where malaria is endemic, or undergoing oral or invasive gastrointestinal surgery in a person who is susceptible to subacute bacterial endocarditis. After the client contracts malaria, it is much harder to treat so they would not start the medication or obtain treatment after being infected. Malaria is treatable.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 90, Introduction 22. The nurse is administering an anti-infective medication that is known to lack total selective toxicity. What consequence should the nurse anticipate? A) Some healthy cells will be damaged. B) All pathogens in the body will be destroyed. C) The microbe’s enzyme production will be slowed. D) Bacterial DNA will mutate.

Ans: A

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Feedback: When a drug does not display selective toxicity, healthy cells are damaged because the drug does not specifically target only the pathogen. Anti-infectives work by a variety of different means so one drug is not likely to kill every type of pathogen in the body. Selective toxicity does not impact enzyme production or cause mutation.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 2 Page and Header: 91, Therapeutic Actions 23. Which classification of anti-infective medication would the nursing instructor discuss when lecturing nursing students about infecting requiring selectivity in their actions? A) broad spectrum B) narrow spectrum C) bactericidal D) bacteriostatic

Ans: B

Feedback: Some anti-infectives are so selective in their action that they are effective against only a few, or possibly only one, microorganism with a very specific metabolic pathway or enzyme. These drugs are said to have a narrow spectrum of activity. They are not called broad spectrum, which applies to a drug with little selectivity; bactericidal, which is a substance that causes death of bacteria; or bacteriostatic, which prevents replication of a bacterium.

Format: Multiple Selection

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Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 96, Adverse Reactions to Anti-Infective Therapy; 9.6, Box 8.4 24. The nurse administers an anti-infective to a client. What constellation of symptoms should cause the nurse to suspect drug fever, hold the medication, and call the health care provider immediately? Select all that apply. A) loss of hearing B) dizziness C) vertigo D) increased activity E) hallucinations

Ans: A, B, C, E

Feedback: Some anti-infectives can damage or interfere with the function of nerve tissue, usually in areas where drugs tend to accumulate in high concentrations. For example, the aminoglycoside antibiotics collect in the eighth cranial nerve and can cause dizziness, vertigo, and loss of hearing. Other anti-infectives can cause dizziness, drowsiness, lethargy, changes in reflexes, and even hallucinations when they irritate specific nerve tissues. This drug is reserved for infections that do not respond to less toxic drugs; the nurse needs to be alert for serious reactions and hold the drug until notifying the provider.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Teaching/Learning Objective: 4 Page and Header: 91, Therapeutic Actions; 94, Box 8.3 25. The client in the clinic receives a prescription for an anti-infective to treat a urinary tract infection. The client asks the nurse, “Would you ask the doctor to give me refills on this prescription? I get a urinary tract infection every few months, it seems, and I’d like to have a refill on hand for next time.” What is the nurse’s best response? A) “Sure, I’d be glad to ask. How many refills do you think you would need?” B) “Most medications, if not used, should be discarded after a year so it is better to get a new prescription next year when you need it.” C) “This antibiotic doesn’t destroy every virus that could cause a urinary tract infection so it is better to get a different antibiotic next time.” D) “Saving antibiotics for another time and trying to diagnose your own health problems can lead to resistant organisms that no longer respond to drugs.”

Ans: D

Feedback: Clients should not be given refills to use indiscriminately. The priority is teaching this client about drug-resistant organisms and how they can be prevented, as well as what happens if an infection results from a resistant organism. The expiry date of medications is not relevant to the discussion. Antibiotics are not used to treat viruses.

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sensitivity testing. The client states, “I’d prefer vancomycin because I’ve been reading about drug-resistant bacteria and I don’t want to take any chances.” What is the nurse’s best response? A) “Vancomycin is a powerful drug with many adverse effects, and it is generally reserved for when no other drug will work.” B) “There are some resistant infections that require vancomycin so you are right to prefer a stronger antibiotic.” C) “I appreciate your concern but you can certainly rest assured that the doctor ordered the right medication for your needs.” D) “You can’t believe anything you read on the internet because most of it is just someone’s opinion and not fact.”

Ans: A

Feedback: The client is right in saying that vancomycin is effective against drugresistant bacteria but needs help to understand that they do not have a resistant infection as indicated by the culture and sensitivity and that use of such a powerful drug when it is not needed increases risk of developing a vancomycin-resistant infection. It is never right to tell a client “not to worry” because they have every right to participate in their own care and should not be patronized. Although some information on the internet may not be accurate, it would be incorrect to say it is all just someone’s opinion and not fact, especially given that the client’s information is accurate.

Format: Multiple Selection Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 4 Page and Header: 90, Introduction; 91, Box 8.1

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27. The parent of a toddler is upset that antibiotics have not been prescribed for the toddler’s middle ear infection that has accompanied a viral respiratory infection. What should the nurse include in the teaching plan? Select all that apply. A) Ear infections that accompany viral respiratory infections do not respond to antibiotics. B) Habitual use of antibiotics for viral infections contribute to development of resistant strains. C) Adverse effects from antibiotics in children can cause diarrhea and dehydration. D) Antibiotics will only be prescribed if a culture indicates the presence of bacteria in the ear. E) The pediatrician’s actions are based on scientific evidence and they are trustworthy.

Ans: A, B, C

Feedback: When the child has a viral respiratory infection, the organism involved in ear infections is usually viral as well. As a result, antibiotics will have no effect on the infection that will resolve independently and only comfort care is indicated. Habitual use of antibiotics for viral infections contributes to the development of resistant strains of bacteria, and the adverse effects can make the child more uncomfortable causing diarrhea and dehydration. Cultures of ear fluid are almost never done because it would be an invasive procedure to remove fluid from the middle ear. Saying the provider is trustworthy deflects the client’s concerns.

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28. A client who has been prescribed an antifungal medication to address a skin infection asks how the medication works. The nurse should base the response on what fact? Select all that apply. A) The fungal cell’s DNA synthesis is interfered with resulting in cell death. B) The medication affects the permeability of the cell membrane causing fungal cell’s death. C) The medication interferes with the fungal cells’ ability to divide resulting in ultimate cell death. D) The fungal cell is rendered incapable of using substances essential to its growth and survival.

Ans: B

Feedback: Antifungals work by altering the permeability of the cell membrane to allow essential cellular components to leak out, causing cell death. The other options relate to methods of actions for other types of anti-infectives.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 94, Using Anti-Infective Agents 29. A client has presented with signs and symptoms suggesting a bacterial infection. What is the initial step in the treatment process? A) informing the client of the need to obtain a laboratory sample for culturing B) discussing information regarding the prescribed medication therapy C) assessing the client for known medication allergies D) determining the client understanding of the implications of such an infection

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Ans: A

Feedback: Identification of the infecting pathogen is done by culturing a tissue sample from the infected area. The correct identification of the organism causing the infection is an important first step in determining which anti-infective drug should be used. Identification of the infecting pathogen is done by culturing a tissue sample from the infected area. Medication therapy and the presence of known medication allergies are not appropriate until the culture identifies the causative agent of the infection. It is then appropriate to assess the client’s understanding of such an infection.

Format: Multiple Selection Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 91, Therapeutic Actions 30. A client has been diagnosed with a systemic infection and will be prescribed an antiinfective drug regimen. What are the priority consideration(s) directing the selection of this regimen? Select all that apply. A) identifying risk of allergic reactions B) minimizing complications C) maximizing effectiveness D) containing cost E) minimizing hospitalization stay

Ans: B, C

Feedback: Many infections that once led to lengthy, organ-damaging, or even fatal illnesses are now managed quickly and efficiently with the use of systemic anti-infective agents. Several factors should be considered before beginning a systemic anti-infective

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regimen. These factors include identification of the correct pathogen and selection of a drug that is most likely to (1) cause the fewest complications for that client and (2) be most effective against the pathogen involved. While appropriate considerations, the remaining options do not have priority over effectiveness and complication prevention.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 90, Introduction 31. An individual who recently returned from a 3-week trip to a remote village out of the country is diagnosed with intestinal worms. What classification of medication should the nurse be prepared to discuss with this client? A) antifungal B) antiprotozoal C) anthelmintic D) antineoplastic

Ans: C

Feedback: Anthelmintics are prescribed for infections caused by worms. Fungal infections are treated with an antifungal, while protozoal infections like malaria are treated with antiprotozoals. Neoplastic medications are used to treat cancers.

Test Generator Questions, Chapter 9, Antibiotics Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 139, Miscellaneous Antibiotics; 103, Box 9.1 1. A 32-year-old female client has been diagnosed with a superinfection and has been prescribed tigecycline. What is a priority nursing action? A) Assess the client’s blood pressure prior to administering the first dose and monitor closely for the first 12 hours. B) Educate the client about the need to avoid OTC antihistamines during treatment, due to the risk for anticholinergic effects. C) Educate the client about the need to supplement oral contraceptives with another form of birth control. D) Assess the client carefully for recreational drug use.

Ans: C

Feedback: Many antibiotics interfere with the effectiveness of oral contraceptives, and unplanned pregnancies can occur. Women should be advised to use a barrier form of contraceptives when taking this drug. This client would be unlikely to experience blood pressure fluctuations. Antihistamines and recreational drug use should be identified, but the need for contraception is a priority in a female client of this age.

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2. A client with a gram-negative infection is being treated with an aminoglycoside. What assessment should the nurse prioritize during treatment? A) breath sounds and oxygen saturation B) visual acuity C) urine output and BUN and creatinine levels D) muscle strength and coordination

Ans: C

Feedback: Renal function should be tested daily because aminoglycosides depend on the kidney for excretion, and if the glomerular filtration rate (GFR) is abnormal, it may be toxic to the kidney. The results of the renal function testing could change the daily dosage. Aminoglycosides do not usually adversely affect respiratory or musculoskeletal function, although baseline data concerning these systems are always needed. Auditory effects are more likely than visual effects.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 102, Bacteria and Antibiotics 3. A nurse is preparing to administer a prescribed antibiotic and is aware that the medication is selectively toxic. What does the nurse understand about this medication? A) It interferes with a biochemical reaction common to many different organisms. B) It kills invading bacteria by interfering with the pathogens’ ability to reproduce. C) It eliminates bacteria by interrupting protein synthesis and damaging the pathogen’s cell wall. D) It is able to kill foreign cells without causing significant harm to the client’s own body cells.

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Ans: D

Feedback: The choice of antibiotics in a clinical situation is determined by assessing which drug will affect the causative organism and lead to the fewest adverse effects. Selective toxicity is the ability of the drug to kill foreign cells without causing harm to the human body cells. How the antibiotic works to kill bacteria varies by drug type and may reduce the ability to reproduce, damage the cell wall, or interfere with a biochemical reaction, but this is a description of how the antibiotic works and does not describe selective toxicity.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4, 5 Page and Header: 114, Fluoroquinolones; 114, Table 9.4 4. A local bioterrorism medical team is responding to a possible anthrax attack. The team is instructed that a fluoroquinolone may be used to treat exposure to anthrax. The nurse should prepare to administer what antibiotic? A) ciprofloxacin B) gemifloxacin C) amoxicillin D) sparfloxacin

Ans: A

Feedback: Ciprofloxacin is used to treat exposure to anthrax. Gemifloxacin and sparfloxacin are most useful in treating acute episodes of chronic bronchitis and community-acquired pneumonia. Amoxicillin is a penicillin, not a fluoroquinolone.

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Format: Fill-in-the-Blank Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 110, Cephalosporins; 112, Box 9.4 5. A clinic nurse is caring for a 66-pound child who has acute otitis media. The health care provider (HCP) has ordered a cephalosporin with a dosage of 9 mg/kg per day PO. One dose per day for 10 days. The drug comes in an oral suspension of 90 mg/5 mL. How many milliliters should the nurse administer? Round your answer to a whole number.

Ans: 15 mL

Feedback: First, using the formula: 2.2 lb/1 kg = 66 lb/X kg, determine the child’s weight in kilograms (66/2.2 = 30 kg). Next, determine the desired dose by using the formula: amount of prescribed drug times weight in kg (9 mg/kg times 30 kg = 270 mg). To determine the volume of medication to administer, use the formula: amount of drug available/volume available = amount of drug prescribed/volume to administer (90 mg/5 mL = 270 mg/X mL, 90 mg/(X) = 1,350 mg/mL, X = 15 mL).

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Page and Header: 135, Macrolides; 133, Table 9.9 6. An 82-year-old client, who lives alone and has occasional memory lapses, is being seen by the home health nurse. In reviewing the client’s medication, the nurse discovers that the client was recently prescribed azithromycin for urethritis. What characteristic of this drug makes it an appropriate choice for this client? A) The half-life of the drug is 3 to 7 hours. B) It is taken only once a day. C) The drug usually achieves results in only a 3-day course. D) Zithromax is associated with very few drug–drug interactions.

Ans: B

Feedback: Given that the client has occasional memory lapses and lives alone, a daily dose would likely promote improved adherence. Azithromycin can be administered once daily because the half-life is 68 hours. Azithromycin may adversely interact with cardiac glycosides, oral anticoagulants, theophyllines, carbamazepine, and corticosteroids to name a few agents. The course of treatment is likely to exceed 3 days.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 128, Antituberculosis Drugs; 129, Table 9.8 7. A 10-year-old client diagnosed with tuberculosis has been admitted to the pediatric unit. The health care provider (HCP) has ordered rifampin. What is the nursing priority? A) Transcribe the order to the medication administration record (MAR). B) Perform hand hygiene before preparing the medication. C) Assess the client’s renal and hepatic functions. D) Question the order by calling the health care provider.

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Ans: D

Feedback: The nurse should call the HCP and question the order because this drug is not recommended for children younger than 12 years of age. Following clarification of the order, the drug would be transcribed and listed in the MAR. The nurse would then wash their hands before preparing the drug for administration. Assessment of renal and hepatic function is good practice before administering any medication but is not the nursing priority in this particular case.

Format: Multiple Selection Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 131, Clinically Important Drug–Drug Interactions 8. A female client with a history of deep vein thrombosis (DVT) has been diagnosed with tuberculosis and has been prescribed rifampin 600 mg PO daily. What health education should the nurse prioritize? Select all that apply. A) the need to revisit currently prevented means of birth control B) the need to avoid grapefruit juice for the duration of treatment C) the need to limit activity level until the adverse effects are known D) the need to adjust warfarin dosage E) the need to avoid alcohol consumption to minimize risk of liver damage

Ans: A, D

Feedback: Rifampin accelerates metabolism of warfarin, oral contraceptives, protease inhibitors, and nonnucleoside reverse transcriptase inhibitors, which can lead to decreased effectiveness of medication treatment. There is no need to limit activity.

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Grapefruit juice is not contraindicated. Avoiding alcohol is a prudent intervention, but it is not directly related to rifampin.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 124, Tetracyclines 9. The nurse is providing discharge teaching to a client who is being sent home on oral tetracycline. What instructions should the nurse include? A) Take the medication only once a day. B) Hold the drug if pulse is lower than 60 beats per minute (bpm). C) Take the drug on an empty stomach. D) Take the medication with two ounces of water.

Ans: C

Feedback: Tetracycline should be taken on an empty stomach 1 hour before or 2 hours after meals with a full eight ounces of water to ensure full absorption. Tetracycline is usually taken at least once every 12 hours. Checking the pulse and holding the dose if below 60 bpm is an action specific to the use of cardiac glycosides.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 5 Page and Header: 121, Nursing Conclusions 10. A young adult client who has no significant prior health history has been prescribed antibiotics for the first time. What nursing conclusion would be most appropriate for this client? A) acute pain related to gastrointestinal (GI) effects of the drug B) deficient knowledge regarding drug therapy C) imbalance nutrition: less than body requirements related to multiple GI effects of the drug D) constipation related to increased fluid absorption

Ans: B

Feedback: Because this is the first time the client has taken antibiotics, they are likely to have limited knowledge about the drug. The client may not understand the importance of taking the medication as ordered to increase effectiveness of the drug or to report adverse effects. Because the client has not started the drug yet, there is no way to know what adverse effects, if any, they will experience.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 101, Aminoglycosides 11. The client has been diagnosed with a serious infection caused by gram-negative aerobic bacilli. The client has been prescribed IV gentamicin. What statement by the client should the nurse follow up most promptly? A) “I feel like I’m having trouble hearing the last little while.” B) “I definitely feel like my appetite has suffered since I started these antibiotics.”

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C) “My IV site feels really itchy a lot of the time.” D) “I’ve got this pounding headache that never seems to go away.”

Ans: A

Feedback: Gentamicin is associated with serious and possibly irreversible ototoxicity, which must be addressed immediately. For this reason, it is a priority over anorexia, headache, or pruritus at the IV site.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 102, Bacteria and Antibiotics; 104, Box 9.3 12. The nurse is collaborating with the health care provider (HCP) of a client who presented with signs and symptoms of an infection. What information should the nurse prioritize so that the HCP can prescribe the proper antibiotic? A) first day of infection symptoms B) culture and sensitivity test results C) the client’s intake and output for past 2 days D) results of complete blood count with differential

Ans: B

Feedback: Antibiotics are best selected based on culture results that identify the type of organism causing the infection and sensitivity testing that shows what antibiotics are most effective in eliminating the bacteria. First day of symptoms of infection is likely already known if culture and sensitivity testing has been performed. Although measurement of intake and output is one indicator of renal function, a blood–urea–

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nitrogen test and assessment of creatinine levels would be better ways of assessing renal function, which will be used to determine dose of medication but not for selection of the correct antibiotic. The white blood cell count with differential would indicate the possibility of an infection but are not needed in choosing the proper antibiotic.

Format: Multiple Selection Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 104, Bacteria and Resistance to Antibiotics; 104, Box 9.3 13. The nurse has cared for an increasing number of clients who have antibiotic resistance. What principles should the nurse and the other members of the care team follow in order to prevent antibiotic resistance? Select all that apply. A) Avoid broad-spectrum antibiotics when treating trivial or viral infections. B) Use narrow-spectrum agents if they are likely to be effective. C) Teach clients not to save antibiotics for self-medication in the future. D) Treat infections with tetracyclines or penicillins whenever possible. E) Perform culture and sensitivity testing immediately after starting a course of antibiotics.

Ans: A, B, C

Feedback: To prevent or contain the growing threat of drug-resistant strains of bacteria, it is very important to use antibiotics cautiously, to complete the full course of an antibiotic prescription, and to avoid saving antibiotics for self-medication in the future. Antibiotic treatment of minor or viral infections is linked to antibiotic resistance. Narrow-spectrum antibiotics are less likely, overall, to lead to resistance. The use of tetracyclines or penicillins does not necessarily reduce antibiotic resistance. Culture and sensitivity testing should take place before beginning therapy, whenever possible.

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Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 1, 5 Page and Header: 128, Antituberculosis Drugs 14. A client has been prescribed isoniazid (INH) 250 mg PO daily. What nursing action should the nurse prioritize? A) Monitor the client closely for signs of hemorrhage. B) Teach the client to avoid iron supplements. C) Contact the provider to clarify the order. D) Place the client on respiratory isolation precautions.

Ans: D

Feedback: INH is used to treat tuberculosis, which would mean that the client requires respiratory isolation. There is no obvious need to avoid iron supplements, and there is no heightened risk of bleeding. The order is within usual parameters for dosage and route, so there is no clear need for confirmation.

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15. The nurse learns that a 7-year-old child has been prescribed tetracyclines several times in recent years. What assessment should the nurse prioritize? A) Assess the client for signs of ototoxicity. B) Assess the client’s deep tendon reflexes. C) Inspect the client’s teeth. D) Inspect the client’s skin and sclerae for jaundice.

Ans: C Feedback: Use tetracyclines with caution in children younger than 8 years of age because they can potentially damage developing bones and teeth. Tetracyclines are not closely linked to ototoxicity or hepatic damage. CNS effects such as decreased deep tendon reflexes are unlikely.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 116, Penicillins and Penicillinase-Resistant Antibiotics; 121, Box 9.5 16. The nurse has administered the first dose of a client’s newly prescribed penicillin. What assessment finding should the nurse interpret as adverse effect that suggests a more serious concern? A) rash to the face and trunk B) new onset of pain C) decrease in blood pressure from 128/77 mm Hg preadministration to 119/70 postadministration D) drowsiness

Ans: A

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Feedback: A rash poses no threat in and of itself but suggests the possibility of drug intolerance or hypersensitivity. A modest decrease in blood pressure or level of consciousness would be less clinically significant. The nurse must address the client’s pain, but this is unlikely to be a consequence of antibiotic use.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 101, Aminoglycosides 17. The nurse is caring for a client who is receiving IV gentamicin and who reports difficulty hearing this morning. What should the nurse do? A) Hold the dose and notify the prescriber immediately. B) Make a referral for auditory testing. C) Administer the dose and report this information to the oncoming nurse. D) Administer the dose and document the finding in the client’s health record.

Ans: A

Feedback: Aminoglycosides are contraindicated in the following conditions: known allergy to any of the aminoglycosides; renal or hepatic disease that could be exacerbated by toxic aminoglycoside effects and that could interfere with drug metabolism and excretion, leading to higher toxicity; preexisting hearing loss, which could be intensified by toxic drug-related adverse effects on the auditory nerve. Ototoxicity should be reported, and the drug should be stopped. Hearing assessment may be deemed necessary, but the priority is to hold the dose and contact the provider.

Format: Multiple Choice

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Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 114, Fluoroquinolones 18. The nurse is providing client teaching before discharging a client home. The client is taking ciprofloxacin. What action should the nurse encourage the client to prioritize? A) Eliminate red meat and seafood from the diet. B) Drink at least 2 L of fluid per day. C) Avoid all caffeine and alcohol. D) Minimize sodium intake.

Ans: B

Feedback: Clients should be encouraged to drink a lot of fluids and maintain nutrition, even though nausea, vomiting, and diarrhea may occur. There is no need to eliminate red meat, seafood, caffeine, or alcohol from the diet, although alcohol may increase the risk of GI irritation. There is no need to minimize sodium intake.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 122, Sulfonamides 19. The nurse is caring for a client whose current drug regimen includes trimethoprim/sulfamethoxazole (cotrimoxazole). What assessment finding would most likely indicate a therapeutic effect?

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A) The client’s surgical incision is well-approximated with no exudate. B) The client denies dysuria, and the urine is clear and odorless. C) The client’s diarrhea has resolved. D) The client’s lungs are clear on auscultation.

Ans: B

Feedback: Cotrimoxazole is often prescribed for urinary tract infections; clear urine with no dysuria would suggest that the medication has been effective. This drug is not as commonly prescribed for GI infections, respiratory infections, or wound infections.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 114, Fluoroquinolones 20. When caring for a pediatric client, the nurse should question an order for what drug? A) amikacin B) cefazolin C) streptomycin D) levofloxacin

Ans: D

Feedback: Fluoroquinolones are not recommended for use in clients who are younger than 18 years of age. Levofloxacin is the only fluoroquinolone among the answer options and is contraindicated for pediatric clients under age 18. The other listed drugs may be used if necessary. Format: Multiple Choice

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Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 101, Aminoglycosides 21. The nurse is caring for a client who is receiving amikacin for the treatment of a serious Staphylococcus aureus infection. What assessment should the nurse prioritize? A) urine output and creatinine clearance B) vision assessment C) cardiac monitoring D) skin assessment and monitoring of liver enzyme levels

Ans: A

Feedback: Aminoglycosides such as amikacin come with a black box warning alerting health care professionals to the serious risk of nephrotoxicity. Visual alterations are not usually reported in relation to this drug. Similarly, cardiac and liver functions are not usually impacted by this drug.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 110, Cephalosporins 22. The nurse provides discharge teaching for a female client who will receive a prescription for cefaclor. What important information should the nurse provide this client?

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A) Adverse reactions include the development of a urinary tract infection. B) Vaginal itching will go away after the drug is discontinued. C) Monitor for yellowing of the skin or eyes and call the doctor if it occurs. D) Avoid grapefruit juice when taking this medication to prevent adverse effects.

Ans: B

Feedback: Genital itching in women indicates the possibility of a superinfection. One of the reasons this medication is typically prescribed is for a urinary tract infection. Liver damage, indicated by jaundice, is not a likely adverse effect with this drug. There is no need to avoid grapefruit juice.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 116, Penicillins and Penicillinase-Resistant Antibiotics; 121, Box 9.5 23. The nurse is providing discharge education to a client who is leaving with a prescription for PO ampicillin. What should the nurse teach the client? A) Discoloration of the tongue may occur but will subside when the drug is discontinued. B) Even if it seems like the infection is worsening, the drug is still working. C) Yeast infections are unlikely to occur with this medication because it is narrow spectrum. D) Appearance of a rash is common and does not indicate an allergic reaction.

Ans: A

Feedback: One of the adverse effects of ampicillin is blackening of the tongue, but the discoloration goes away after stopping the drug. If it is accompanied by swelling, the

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client should be instructed to call the prescribing health care provider (HCP) immediately. Many penicillin-resistant pathogens exist, so if the infection does not seem to be responding to the drug, the client should notify the HCP because a different antibiotic may be required. Yeast infections are very likely after taking ampicillin because it is a broad-spectrum antibiotic. Appearance of a rash should be evaluated by a health care professional because allergic reactions to this class of antibiotic are very common.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 102, Carbapenems; 108, Table 9.2 24. The nurse is caring for a client who has been prescribed imipenem–cilastatin. For which condition is this usually prescribed? A) septicemia B) otitis media C) sinusitis D) acne vulgaris

Ans: A Feedback: Carbapenems are reserved for serious infections such as septicemia. Less serious infections, such as ear infections, sinus infections, or skin infections (acne) would likely be treated with alternative antibiotics.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 124, Tetracyclines 25. The clinic nurse is providing health teaching to a client who has been prescribed doxycycline. What is a priority teaching point for this client? A) Stay out of the sun as much as possible. B) Avoid sexual activity for the duration of treatment. C) Avoid grapefruit juice for the duration of treatment. D) Chew the tablets completely before swallowing.

Ans: A

Feedback: Encourage the client to apply sunscreen and wear protective clothing if sun exposure cannot be avoided to protect exposed skin from rashes and sunburn associated with photosensitivity reactions. If the client is a woman, the nurse may advise the client to use barrier methods of contraceptives (if they are taking oral contraceptives) due to the drug–drug interaction, but the client would not be told to avoid sexual activity. Tablets should not be chewed, and grapefruit juice is not contraindicated.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 116, Penicillins and Penicillinase-Resistant Antibiotics 26. The parent of an 8-year-old child asks the nurse why it seems amoxicillin is so often prescribed when the child needs an antibiotic. What is the nurse’s best response? A) “Amoxicillin is better absorbed than many other antibiotics and it’s highly effective.”

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B) “Amoxicillin is an inexpensive antibiotic, so clients are more likely to follow through with treatment.” C) “Amoxicillin has the benefit of once-daily dosing, which is easier for both parents and children.” D) “Amoxicillin is effective and has a less offensive taste than many antibiotics.”

Ans: A

Feedback: Most penicillins are rapidly absorbed from the GI tract, reaching peak levels in 1 hour. Although amoxicillin is less expensive, that fact has far less impact on choosing the proper antibiotic than the effectiveness of the drug. Most oral antibiotics for children are available in pleasant tasting syrups so taste would not be a factor. Amoxicillin must be given q8h.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 116, Penicillins and Penicillinase-Resistant Antibiotics; 117, Table 9.5 27. A client has been diagnosed with a sinus infection, and the client has been given a prescription for amoxicillin. What teaching point should the nurse make for the client? A) “Make sure you tell your prescriber if you’re feeling particularly tired.” B) “Avoid taking the medication right before bed so it doesn’t cause frequent trips to the bathroom.” C) “Take your medication every 8 hours, as it’s been prescribed.” D) “This might cause crystals in your urine, so drink plenty of fluids.”

Ans: C

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Feedback: Amoxicillin is almost always given q8h. This necessitates a bedtime dose for most clients, and the drug has no diuretic effect. Extreme or long-standing fatigue should be reported, but this is unlikely to be an adverse effect of the medication.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 128, Antimycobacterials 28. The nurse is caring for a client receiving an antimycobacterial who reports dizziness, headache, and drowsiness. What nursing diagnosis is most likely to relate to this client’s adverse drug effects? A) imbalanced nutrition: less than body requirements B) altered sensory perception (kinesthetic) related to central nervous system (CNS) effects of the drug C) acute pain related to gastrointestinal (GI) effects of the drug D) deficient knowledge regarding drug therapy

Ans: B

Feedback: The priority concern for this client right now is the disturbed sensory perception related to the CNS effects of the drug. Acute pain could also be used, but it would be related to CNS effects, not GI effects. There is no indication of imbalanced nutrition or deficient knowledge in the question.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 105, Aminoglycosides 29. The client is admitted to the acute care facility with acute septicemia and has orders to receive gentamicin and ampicillin IV. The nurse is performing an admission assessment that includes a complete nursing history. What information provided by the client would indicate the need to consult the health care provider (HCP) before administering the ordered medication? A) takes high-dose furosemide daily B) had prostate surgery 3 months ago C) history of hypothyroidism D) allergy to peanuts and peanut products

Ans: A

Feedback: Aminoglycosides should be avoided if the client takes a potent diuretic because of the increased risk of ototoxicity, nephrotoxicity, and neurotoxicity. Learning the client takes a potent diuretic would indicate the need to consult with the health care provider (HCP) before administering gentamicin. Prostate surgery, hypothyroidism, and an allergy to peanuts would not preclude administration of these medications and would not indicate a need to consult with the health care provider.

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30. When the nurse cares for a client receiving an antibiotic, what instructions should the nurse provide no matter what medication is prescribed? Select all that apply. A) Drink plenty of fluids to avoid kidney damage. B) Take all medications as prescribed until all of the medication is gone. C) Report difficulty breathing, severe headache, or changes in urine output. D) Take antibiotic with food to avoid gastrointestinal (GI) upset. E) Take safety precautions such as changing position slowly.

Ans: A, B, C

Feedback: The client taking any antibiotic needs to drink plenty of fluids to avoid kidney damage and improve excretion of the metabolized drug; take all medications as prescribed until all of the medication is gone to avoid developing a resistant strain of bacteria; and report any difficulty breathing, severe headache, or changes in urine output because these are primary manifestations of serious adverse effects. Although some antibiotics need to be taken with food, others may be best taken on an empty stomach so this does not apply to all antibiotics. Not all antibiotics are associated with central nervous system (CNS) toxicity so taking safety precautions need only be included in client teaching if they are taking a drug associated with CNS adverse effects.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 3, 4, 5 Page and Header: 124, Tetracyclines 31. The nurse is admitting a 12-year-old child to the acute care facility and notices discolored secondary teeth. The parent says they doesn’t know why the teeth are discolored because the child is very good about brushing and flossing and sees the dentist regularly. What question should the nurse ask?

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A) “Have they ever received tetracycline?” B) “Have they ever received gentamicin?” C) “Have they ever received ampicillin?” D) “Have they ever received cephalexin?”

Ans: A

Feedback: The nurse would question whether the child was ever given tetracycline because this drug is commonly associated with discoloration of secondary teeth when it is administered to children who still have their primary teeth. Gentamicin, ampicillin, and cephalexin are not associated with discoloration of the teeth.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 128, Antituberculosis Drugs 32. The nurse is caring for a female client whose tests confirm they are 10 weeks pregnant and has contracted tuberculosis. The health care provider orders a combination of antimycobacterials. What combination of drugs should the nurse identify as safest for this pregnant client? A) isoniazid, ethambutol, and rifampin B) rifabutin, streptomycin, and rifampin C) capreomycin, cycloserine, and ethionamide D) dapsone, ethambutol, and cycloserine

Ans: A

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Feedback: The antituberculosis drugs are always used in combination to affect the bacteria at various cellular stages, and first-line drugs are always the first choice, using second-line drugs only when the client is unable to take the first-line medications. Because this client is pregnant, the safest choices would be isoniazid, ethambutol, and rifampin, but no drug is administered during pregnancy unless the benefit outweighs the risk. The other drug choices would be less safe and would not be used unless the safer drugs were contraindicated. Format: Multiple Selection Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 101, Bacteria and Resistance to Antibiotics 33. Which client(s) prescribed an antibiotic should be identified as possibly presenting signs and symptoms of a superinfection? Select all that apply. A) a 34-year-old female who reports additional white vaginal discharge with pruritus B) a 20-year-old male with an itchy rash on the left leg C) a 15-year-old client presenting with oral thrush D) a 68-year-old client reporting diarrhea for the last 7 days E) a 14-month-old child experiencing constipation

Ans: A, C, D

Feedback: The use of antibiotics may result in the development of superinfections or overgrowth of resistant pathogens, such as bacteria, fungi, or yeasts, because antibiotics (particularly broad-spectrum agents) destroy bacteria in the flora that normally work to keep these opportunistic invaders in check. When “normal” bacteria are destroyed or greatly reduced in number, there is nothing to prevent the invaders from occupying the host. In most cases, the superinfection is an irritating adverse effect (e.g., vaginal yeast infection, thrush, diarrhea), but in some cases, the superinfection can be more severe

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than the infection that was originally being treated. Neither a simple rash nor constipation is generally associated with a superinfection related to antibiotic therapy.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 102, Bacteria and Antibiotics; 103, Box 9.1 34. The nurse is engaged in a conversation with a client newly prescribed an antibiotic. What client statement represents a commonly held misconception about antibiotic medications? A) “Antibiotics are expensive and not generally covered by medical insurance.” B) “An antibiotic will likely be effective for a multitude of infections and so can be shared.” C) “When you start feeling better, the antibiotic should be stopped.” D) “Antibiotics are a cure-all for all discomforts including a fever.”

Ans: D

Feedback: Many adults believe that antibiotics are a cure-all for any discomfort and fever. It is very important to explain that antibiotics are useful against only specific bacteria and actually can cause problems when used unnecessarily for viral infections, such as the common cold. Overuse of antibiotics can cause superinfections, drugresistant bacteria, and a delay in the initiation of effective treatment. Adults need to be cautioned to take the entire course of the medication as prescribed and not to store unused pills for future infections or share antibiotics with symptomatic friends.

Format: Multiple Choice

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Chapter: 9 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: Page and Header: 102, Bacteria and Antibiotics; 103, Box 9.1 35. A nurse is caring for an older client admitted to the acute care unit for a urinary tract infection. Which nursing action is especially important when caring for this older client? A) Frequently assess for fever. B) Restrict fluids to support blood pressure C) Arrange for a urine culture. D) Monitor carbohydrate intake to manage possible hyperglycemia.

Ans: A

Feedback: In many instances, older adults do not present with the same signs and symptoms of infections such as fever as other clients. For example, a urinary tract infection may cause confusion without urinary frequency or discomfort in an older adult. Therefore, assessing the problem and obtaining appropriate specimens for culture is especially important with this population and would have been completed prior to admission. None of the other options are relevant to this situation.

Test Generator Questions, Chapter 10, Antiviral Agents Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 144, Introduction

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1. The nurse caring for a client diagnosed with influenza is explaining why viruses are more difficult to treat than many bacteria. What should the nurse teach the client? A) Viruses are contained inside the human cell and cannot be destroyed without destroying that cell. B) Release of interferons by the host cell makes the virus replicate more quickly allowing the virus to spread. C) Drugs exist to treat all viral infections, but they carry serious adverse effects, and the benefit often does not outweigh the risk. D) Individual antiviral drugs are often effective in treating many different viruses because one virus in a category behaves like others in the same category.

Ans: A

Feedback: Because viruses are contained inside human cells while they are in the body, researchers have difficulty developing effective drugs that destroy a virus without harming the human host. Interferons are released by the host in response to viral invasion of a cell and act to prevent the replication of that particular virus. Some interferons that affect particular viruses can now be genetically engineered to treat particular viral infections. Other drugs that are used in treating viral infections are not natural substances and have been effective against only a limited number of viruses. Very few viruses are treatable with medications; a few more can be prevented through immunization, but most have no known treatment. Each antiviral is generally only suited to treat the single virus it was developed for and will not be effective against other viruses.

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Page and Header: 144, Introduction; 145, Box 10.2 2. The nurse is caring for a school-aged child diagnosed with human immunodeficiency syndrome (HIV). In order to confirm that the client’s prescribed doses of antiretroviral medications are safe and effective, the nurse should obtain what assessment data? A) the client’s neutrophil level B) the client’s age in months C) the client’s comorbidities D) the client’s weight

Ans: D

Feedback: Antiviral medication dosages for children are calculated according to weight. There are no scientific data available concerning dosages based on comorbidities or neutrophil level. Age will be considered, but weight is a key assessment parameter.

Format: Fill-in-the-blank Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 151, Agents for HIV and AIDS; 152, Table 10.3 3. A client taking nevirapine as part of combination therapy for treatment of HIV took 200 mg/daily PO for 14 days. The client is now taking 200 mg PO twice daily. How many milligrams of the medication is the client taking daily?

Ans: 400 mg

Feedback: The client is to take 200 mg twice daily (200 mg × 2 = 400 mg daily).

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Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 149, Agents for Herpes and Cytomegalovirus 4. The nurse is caring for a client diagnosed with cytomegalovirus (CMV). What medication is only administered intravenously? A) cidofovir B) foscarnet C) valacyclovir D) valganciclovir

Ans: B Feedback: Foscarnet is administered IV only. Ganciclovir can be administered by IV and orally. Valganciclovir and Valacyclovir are administered only by the oral route.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 146, Agents for Influenza A and Respiratory Viruses 5. A hospitalized client with complex health is receiving the antiviral baloxavir. What is the nurse’s priority action after administering this medication? A) Monitor vital signs every 30 minutes. B) Decrease fluid intake to prevent drug dilution. C) Keep side rails up and ensure that the client’s call light is at the hand.

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D) Encourage the client to ambulate 10 minutes after each dose.

Ans: C

Feedback: Use of these antiviral agents is frequently associated with various adverse effects that may be related to possible effects on dopamine levels in the brain. These adverse effects include light-headedness and dizziness. This creates a falls risk, so falls prevention measures should be taken. Vital signs should be monitored, but q30min is likely unnecessary frequency. Fluid intake should be encouraged.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 4 Page and Header: 156, Protease Inhibitors 6. A client with renal impairment and HIV has had a medication change. What drug would be considered the drug of choice for this client? A) atazanavir B) lopinavir C) nelfinavir D) ritonavir

Ans: C

Feedback: Nelfinavir is the best choice for a client with renal impairment because very little of the drug is excreted through the kidney, with most being excreted in feces. The other drugs are all excreted through both the urine and feces, so clients with renal impairment might need dosage adjustments to avoid toxicity.

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Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 166, Locally Active Antiviral Agents 7. A resident of a long-term care facility has been prescribed docosanol for the treatment of a cold sore. What action should the nurse perform first? A) Clean the area to be treated and then pat it dry. B) Assess the area for open lesions or abrasions. C) Put on sterile gloves. D) Prepare applicator for drug administration.

Ans: B

Feedback: The nurse should assess the area first to make sure no open lesions or abrasions could allow for systemic absorption of the drug. Then, the nurse would clean the area and pat it dry. The nurse may apply the medication using gloves or an applicator.

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8. A client with HIV is taking a nonnucleoside reverse transcriptase inhibiting (NNRTI) antiviral agent. What comment by the client would indicate that the nurse’s health education was effective? A) “Some of these drugs will make me feel like I have the flu, but they’re still working.” B) “I will continue to take the over-the-counter medication for my allergies, but make sure not to exceed the recommended dose.” C) “Excessive fatigue and a severe headache are common adverse effects of my medication.” D) “This drug will cure HIV over time, provided I adhere closely to the medication plan.”

Ans: A

Feedback: Common adverse effects of antiviral agents are flu-like symptoms, which may be related to the underlying disease. Excessive fatigue and a severe headache can indicate a serious complication and should be reported immediately. Antiviral agents do not cure the disease. The client should avoid OTC medications whenever possible.

Format: Multiple Selection Chapter: 10 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 161, Nursing Care Guide for H.P.: Antiviral Agents for HIV and AIDS 9. The community health nurse is preparing an education session that will include information on hepatitis B. The nurse should describe what routes of transmission? Select all that apply. A) insect bites B) sexual activity C) blood-to-blood contact D) in utero transmission

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E) nonsexual household contact

Ans: B, C, D

Feedback: Hepatitis B is transmitted from one person to another through sexual contact, blood-to-blood contact, or perinatally. It is not transmitted through casual contact. Hepatitis B is not spread by mosquitoes or other insect vectors. Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 159, Nursing Considerations for Patients Receiving Agents for HIV and AIDS 10. The nurse is assessing a client admitted with AIDS whose current antiretroviral regimen includes a nonnucleoside reverse transcriptase inhibitor. What nursing diagnosis related to drug therapy is most likely to be appropriate for this client? A) risk for injury related to central nervous system (CNS) effects of the drug B) excess fluid volume related to renal failure C) malnutrition related to gastrointestinal (GI) effects of the drugs D) deficient fluid volume related to diuretic effects

Ans: C

Feedback: The adverse effects most commonly experienced with these drugs are GI related—dry mouth, constipation or diarrhea, nausea, abdominal pain, and dyspepsia. As a result, this client is most at risk for malnutrition less than body requirements. CNS effects are not common with this classification of drug. Renal failure is not a common adverse effect. Diuresis is not expected. Format: Multiple Choice Chapter: 10

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 159, Integrase Strand Transfer Inhibitors 11. A nurse is caring for a client who is prescribed raltegravir. Which nursing question is most important when assessing the client? A) “When were you initially diagnosed with HIV-1?” B) “Can you please tell me why you are being prescribed this medication?” C) “Are you taking any herbal preparations, especially St. John’s wort?” D) “Have you ever been prescribed raltegravir before?”

Ans: C

Feedback: Raltegravir is a virus-specific enzyme integrase and blocks the formation of the HIV-1 provirus and leads to a decrease in viral load and an increase in active CD4 cells. Clients should avoid the use of St. John’s wort, which can interfere with the effectiveness of INSTIs. While none of the other options are inappropriate, none are more important than determining the use of a substance that would interfere with drug effectiveness.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 154, Nonnucleoside Reverse Transcriptase Inhibitors 12. A client newly diagnosed with HIV is receiving client teaching from the clinic nurse about antiretroviral medications. The nurse should teach the client to report what

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adverse effect related to Steven–Johnson syndrome to a health care provider most promptly? A) dizziness B) constipation C) nausea D) full body rash

Ans: D

Feedback: All options provided have the potential to be an adverse effect of antiviral medications prescribed to treat HIV. Most can be managed through diet or over-thecounter medications, but a rash needs to be reported immediately because it could indicate a potentially serious reaction (Steven–Johnson syndrome) and requires immediate intervention.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 165, Anti–Hepatitis C Agents 13. The nurse is caring for a client diagnosed with chronic hepatitis C. The client has recently relapsed after interferon alfa therapy. The nurse should anticipate the administration of what drug? A) zanamivir B) acyclovir C) cidofovir D) ribavirin

Ans: D

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Feedback: Ribavirin is used in combination with interferon alfa-2b as an oral drug for the treatment of chronic hepatitis C in children and adults who relapse after interferon alfa therapy. Cidofovir is used to treat cytomegalovirus (CMV) in AIDS clients. Ribavirin is used to treat uncomplicated influenza infections. Acyclovir is used for herpes infections.

Format: Multiple Selection Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 166, Locally Active Antiviral Agents 14. The nurse is working with a client who has been prescribed a locally acting antiviral for the treatment of cold sores. The nurse should understand that this medication may eradicate the viral infection by what means? Select all that apply. A) interfere with viral metabolic processes B) interfere with viral replication C) interfere with host metabolic processes D) interfere with viral transcription E) increase antibody production

Ans: A, B

Feedback: These antiviral agents act on viruses by interfering with normal viral replication and metabolic processes. They are indicated for specific local viral infections. The medications do not interfere with the invaded cell or with viral transcription, and they do not increase antibody production.

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Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 146, Agents for Influenza A and Respiratory Viruses 15. A resident of a long-term care facility has just begun a course of rimantadine. What associated nursing action is most appropriate? A) Ensure the client refrains from sexual activity. B) Maintain the client on isolation precautions. C) Educate the client about the care of open facial lesions. D) Educate the client about the treatment of warts.

Ans: B

Feedback: Rimantadine is used for the treatment of influenza A in adults. In a longterm care setting, a client with influenza would be kept on isolation precautions to prevent the spread of infection. Influenza is not associated with warts or open lesions, which would be suggestive of a herpes infection. Sexual activity is highly unlikely, since the client has influenza.

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16. A 25-year-old female client is diagnosed with HIV, and an antiviral is prescribed. What should the nurse include in client teaching about this medication? A) Remain on oral contraceptives for at least 1 month after finishing this medication. B) This drug is also an abortifacient. C) Use barrier contraceptives. D) The drug is considered safe during pregnancy.

Ans: C

Feedback: For antivirals, advise women of childbearing age to use barrier contraceptives if they are taking this drug. The drug has been associated with serious fetal effects, but it has not been associated with spontaneous abortions. Oral contraceptives should not be stopped, and barrier contraceptives should be used in addition.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 149, Agents for Herpes and Cytomegalovirus 17. A client has been prescribed acyclovir to treat an acute varicella-zoster triggered infection. What intervention should the nurse provide regarding initial medication education? A) Discussing the need for kidney function testing to provide information regarding baseline functioning. B) Asking client if they are being treated for any active respiratory disorders. C) Explaining the importance of restricting fluids to minimize negative renal effects. D) Identifying nausea as a rare side effect to this medication therapy.

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Ans: A

Feedback: It is important to evaluate renal function tests to determine a baseline function of the kidneys as well as medication-induced adverse effects on the kidney and the need to adjust medication dosage in the future. Fluid hydration rather than restriction is needed to help maintain effective renal function. GI upset, nausea, and vomiting are common and manageable. While an important assessment focus, respiratory function is not particularly relevant to acyclovir treatment.

Ans: A

Feedback: Cidofovir, which is given by IV infusion, reaches peak levels at the end of the infusion; in studies, it was cleared from the system within 15 minutes after the infusion was completed. It is excreted unchanged in the urine and must be given with probenecid to increase renal clearance of the drug. Paroxetine hydrochloride is an antidepressant; penciclovir is an antiviral cream; prostigmin is an anticholinesterase agent used in myasthenia gravis. None of these drugs are used with cidofovir except for probenecid.

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Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 149, Agents for Herpes and Cytomegalovirus 19. The nurse admits a client for treatment of cytomegalovirus (CMV). The client has been ordered foscarnet, 40 mg/kg q12h given over 2 hours. By what route should the nurse expect to administer this drug? A) Sub q B) IV C) IM D) PO

Ans: B

Feedback: Foscarnet is available in intravenous (IV) form only. It reaches peak levels at the end of the infusion and has a half-life of 4 hours.

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20. A client is being treated for a herpes outbreak, and the health care provider has prescribed acyclovir. In order to screen for potential problems with the client’s excretion of the drug, which assessment data should the nurse review? A) nutritional status B) GGT, AST, ALT, and bilirubin levels C) blood urea nitrogen (BUN) and creatinine levels D) complete blood count and WBC differential

Ans: C

Feedback: The nurse should evaluate the client’s renal function tests to determine baseline function of the kidneys and to assess adverse effects on the kidney and need to adjust the dose of the drug via BUN and creatinine levels. The client’s white cell count, liver function, and nutritional status have comparatively minor effects on excretion.

Format: Multiple Selection Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 149, Agents for Herpes and Cytomegalovirus 21. A client has signs and symptoms of a herpes infection, and the health care provider has stated that acyclovir would be appropriate for the client. What routes of administration would be possible for this client? Select all that apply. A) topical B) intramuscular C) oral D) intrathecal E) intravenous

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Ans: A, C, E

Feedback: Possible routes for the administration of acyclovir include IV, topically, and PO. The drug is not administered intrathecally or intramuscularly.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 144, Introduction; 145, Box 10.1 22. An immunocompromised 15-year-old client, who has been exposed to COVID-19 and exhibiting symptoms for the past 12 hours, has been hospitalized. What medication should the nurse expect to administer? A) remdesivir B) amantadine C) ribavirin D) zanamivir

Ans: A

Feedback: Currently, the only FDA-approved antiviral treatment for COVID-19 is remdesivir. None of the other listed drug options have received FDA approval for this situation.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 5 Page and Header: 162, Anti–Hepatitis B Agents 23. The nurse is providing discharge teaching for a client taking entecavir. What is the priority teaching point for this client? A) “Take the medication for the full week before stopping it.” B) “Sit upright for at least 30 minutes after taking this medication.” C) “Make sure not to stop taking this medication or allow the prescription to run out.” D) “You’ll likely need to take this medication for the rest of your life.”

Ans: C

Feedback: A potential risk for hepatitis B exacerbation could occur when the drugs are stopped. Therefore, teach the client the importance of not running out of the drugs and using extreme caution when discontinuing these drugs. A 1-week course would be unusually brief, and there is no need to sit upright after taking the drug. Lifelong treatment is not normally necessary.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 146, Agents for Influenza A and Respiratory Viruses 24. The nurse is caring for a preschool-aged child who is diagnosed with cystic fibrosis and who has been exposed to influenza A 2 days ago before receiving the appropriate immunization. The child has been mildly symptomatic for 24 hours. Which antiviral medication would best meet this client’s health needs? A) rimantadine B) zanamivir

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C) oseltamivir D) amantadine

Ans: C

Feedback: Oseltamivir is indicated for clients who are symptomatic for less than 2 days. Amantadine is indicated for the prevention of respiratory virus infections and can be given to children older than 1 year of age. This would be appropriate in a child with a chronic respiratory illness who could die as the result of developing a respiratory virus. Zanamivir is not indicated for children younger than 7 years of age. Rimantadine is administered as prophylaxis against influenza A virus in children older than 10 years of age.

Format: Multiple Selection Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 154, Nonnucleoside Reverse Transcriptase Inhibitors 25. The nurse is caring for a client who is prescribed nevirapine after their condition had declined on other antiviral medications. When assessing the client, the nurse recognizes which medications may lead to a drug–drug interaction with this new prescription? Select all that apply. A) oral contraceptives B) protease inhibitors C) St. John’s wort D) ergot derivatives E) antiarrhythmics

Ans: A, B, C

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Feedback: Effectiveness may be lessened if nevirapine is combined with hormonal contraceptives or protease inhibitors. St. John’s wort should not be used with this drug or any nonnucleoside reverse transcriptase inhibitors because a decrease in antiviral effects can occur. Antiarrhythmics are contraindicated when taking delavirdine, not nevirapine. Ergot derivatives are contraindicated with efavirenz, not nevirapine.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 4 Page and Header: 155, Nucleoside Reverse Transcriptase Inhibitors; 152, Table 10.3 26. The nurse is caring for a pregnant woman diagnosed with HIV on prenatal drug screening. What medication should the nurse expect to administer to reduce the risk of maternal-to-fetal transmission of the virus? A) lamivudine B) zidovudine C) stavudine D) tenofovir

Ans: B

Feedback: AZT, or zidovudine, is administered to prevent the transmission of HIV from mother to child and can be administered to both after birth to treat symptomatic HIV. The other medications are not used for this purpose. Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 146, Agents for Influenza A and Respiratory Viruses 27. The client is diagnosed with a viral respiratory infection and will be prescribed oseltamivir. What intervention should the nurse plan to implement initially to best assure safe medication theory? A) Establish client’s ability to afford the anticipated medication therapy. B) Assess for known history of liver dysfunction. C) Assess bowel and bladder function to establish baseline for future evaluation. D) Establish existence of reproductive-related disorders.

Ans: B

Feedback: Assessment for contraindications or caution regarding administration of an antiviral medication would include a history of liver dysfunction since that would likely interfere with drug metabolism and excretion. While the other options are not necessarily inappropriate inquiries, none are directly related to the safe administration of an antiviral medication.

Format: Multiple Selection Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 167, Nursing Considerations for Patients Receiving Locally Active Antiviral Agents: Assessment: History and Examination 28. What intervention should the nurse implement when providing initial care for a client who will be prescribed a locally active antiviral medication? Select all that apply. A) Ask the client if they are allergic to any medications. B) Perform a physical assessment to establish baseline data for future evaluations.

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C) Evaluate for signs of inflammation at the infection site. D) Educate the client on the adverse effects of the prescribed medication. E) Document the location, size, and shape of the lesion(s).

Ans: A, B, C, E

Feedback: Assessing for drug-related allergies, baseline data, and signs of inflammation at the infection site as well as documenting the location, size, and shape of the existing lesion(s) are all interventions that should be initially implemented for this client. Medication education will be a priority once the medication has been prescribed.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 165, Anti–Hepatitis C Agents 29. A client has been newly prescribed velpatasvir, an antihepatitis C medication. What information should the nurse include in medication-related instructions? A) risks represented to fetuses and newborns B) method to effectively monitor blood pressure C) HCV RNA should be undetectable in 1 year D) need to maintain consultation with a respiratory specialist

Ans: A

Feedback: Careful monitoring of possible and existing pregnancy and lactation are critical because the potential effects of these drugs on the fetus or baby are not known. It is important to monitor body temperature to assess for underlying disease. The HCV RNA should be undetectable 12 weeks after finishing the antiviral treatment course.

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While not required, it can be beneficial to consult a liver specialist regarding management of clients with HCV.

Format: Multiple Choice Chapter: 10 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 165, Box 10.6: High Cost of Hepatitis C Drugs 30. A nurse is caring for adult clients diagnosed with hepatic-related disorders awaiting a liver transplant. The nurse recognizes that studies have shown that most clients with what medical diagnosis do not require expensive medication therapy while on the transplantation wait list? A) HIV B) HCV C) HBV D) Cancer

Ans: B

Feedback: The introduction of drugs to treat HCV opened a new therapeutic option for clients with the disease. It is estimated that most of the people awaiting liver transplant are in need of a transplant because of HCV. Most people with the disease, however, do not experience serious liver problems and would do fine without treatment. Some experts have suggested, based on studies, that these drugs should be reserved for use in those with more advanced liver scarring and higher risk. However, multimedia advertisements have marketed the drug to all people who have known chronic HCV, which has raised demand considerably. Insurance companies are very concerned about the ability to cover the cost of these drugs. The remaining options present diagnoses with less controversy related to treatment options.

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Test Generator Questions, Chapter 11, Antifungal Agents Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 172, Introduction 1. A client treated for athlete’s foot has contacted the nurse because they are frustrated with persistent symptoms. The client is requesting a prescription for oral or topical antibiotics. The nurse should reference which characteristic of the treatment of fungal infections? A) Fungi differ from bacteria because they have flexible cell walls that allow for free transfer into and out of the cell. B) Nearly all fungi have developed resistance to antibiotics in recent decades. C) The composition of the protective layers of the fungal cell makes the organism resistant to antibiotics. D) Fungal cell walls contain Candida, which makes the cells rigid and difficulty to penetrate.

Ans: C

Feedback: The nurse should tell the client that the composition of the protective layers of the fungal cell makes the organism resistant to antibiotics so that antibiotics would not have any positive effect. Fungi do differ from bacteria, but the fungus has rigid cell walls that allow for free transfer in and out of the cell. The protective layers contain ergosterol, not Candida, that helps keep the cell wall rigid, not permeable. Antibiotic resistance is not a consideration in the treatment of infections that have a fungal etiology.

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Ans: B

Feedback: Fluconazole is used in the treatment of cryptococcal meningitis and is safe to use in a 1-year-old child. Amphotericin B has many unpleasant adverse effects and is very potent, so it would not be the first or best medication to administer initially but would be reserved for use if fluconazole was not effective. Griseofulvin is given to treat tinea pedis and tinea unguium in children. Ketoconazole is not given to children younger than 2 years because safety has not been established.

Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning

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Objective: 5 Page and Header: 176, Other Antifungal Agents 3. The nurse is teaching the client about a newly prescribed systemic antifungal drug. What sign or symptom should the nurse instruct the client to report to the health care provider immediately? A) unusual bruising and bleeding B) constipation or diarrhea C) red and dry eyes D) increased appetite with weight gain

Ans: A

Feedback: Unusual bruising and bleeding can be an indication of hepatic toxicity, which should be reported immediately. Yellowing of the eyes, not redness, and tearing are also indicative of hepatic toxicity. Usually GI symptoms include nausea and vomiting with antiviral drugs, which could cause decreased appetite and weight loss. These symptoms should be reported if they persist but are not emergency symptoms to report immediately.

Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 178, Topical Antifungals 4. A client who has a tinea infection calls the clinic to report intense local burning and irritation with use of the prescribed topical antifungal drug. Even before asking the client, the nurse should suspect that the client is applying what medication? A) butoconazole B) ciclopirox

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C) econazole D) haloprogin

Ans: C

Feedback: Econazole can cause intense local burning and irritation in treatment of tinea infections. Butoconazole is used to treat vaginal Candida infections. Ciclopirox is used to treat toenail and fingernail tinea infections and does not produce intense burning and irritation. Haloprogin is used to treat athlete’s foot, jock itch, and ringworm infections and is not associated with burning or irritation.

Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 178, Topical Antifungals 5. A client has presented to the nurse with signs and symptoms of a fungal skin infection. What assessment should the nurse prioritize when discussing the possible use of topical antifungals? A) review of liver enzyme levels B) review of the client’s creatinine clearance C) respiratory assessment D) allergy assessment

Ans: D

Feedback: Topical antifungals are not absorbed systemically so they are not metabolized and excreted. As a result, the only contraindication would be an allergy to the drug. Hepatic and renal impairment and respiratory dysfunction would not be

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contraindications because these drugs do not enter the bloodstream and impact these organ systems.

Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 172, Azole Antifungals 6. A client with high serum cholesterol is taking lovastatin. What drug should the nurse question if it were ordered for this client? A) clotrimazole B) ciprofloxacin C) itraconazole D) oxazepam

Ans: C

Feedback: Itraconazole is an azole antifungal drug that has been associated with severe cardiovascular events when taken with lovastatin. Clotrimazole, ciprofloxacin, and oxazepam have no drug interactions with lovastatin. The effects of ciprofloxacin are altered when taken with antacids and theophyllines. Oxazepam is an antianxiety drug that should not be taken with alcohol or theophyllines.

Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 5 Page and Header: 178, Topical Antifungals 7. A resident of an extended-care facility has athlete’s foot. After applying the prescribed antifungal cream, what should the nurse do next? A) Wipe away excess medication from the affected area. B) Wrap a sterile rolled gauze dressing around both feet. C) Elevate the client’s feet for 30 minutes. D) Apply clean dry socks.

Ans: D

Feedback: Clean dry socks should be applied when treating athlete’s foot to help eradicate the infection because they will keep the feet dry as well as prevent the cream from being wiped away. A rolled gauze dressing is not necessary as it would bind the feet and interfere with mobility and increase the risk of systemic absorption. Medication should not be removed once applied, and there is no need to elevate the feet unless another medical condition warrants this action.

Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 178, Topical Antifungals 8. A client presents to the clinic and is diagnosed with a vaginal fungal infection. What should the nurse teach the client about self-administration of the prescribed vaginal antifungal medication? A) “Insert low into the opening of the vagina.” B) “Temporarily discontinue the medication when you’re menstruating.”

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C) “Stay lying down for at least 15 minutes after insertion.” D) “Gently rub the cream into your vaginal wall after insertion.”

Ans: C

Feedback: The client should remain recumbent for at least 10 to 15 minutes after the medication is deposited high in the vagina so that leakage will not occur and absorption will take place. The effectiveness of the medication is determined by the consistent application for each specified dose for maximal results. The nurse would instruct the client to continue the medication during menstruation. Stopping the drug and restarting it later can lead to the development of resistant strains of the drug. The cream need not be rubbed into the vaginal wall as it will coat the wall naturally after insertion.

Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 5 Page and Header: 178, Topical Antifungals 9. A client who is using a topical antifungal agent to treat mycosis calls the clinic to report a severe rash that is accompanied by blisters. What should the nurse instruct the client to do? A) “Make an appointment so you can be tested for allergies.” B) “Scrub the rash gently with soap and water.” C) “Stop using the drug immediately.” D) “Decrease the amount of the medication used.”

Ans: C

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Feedback: The client should stop using the drug. The rash could indicate sensitivity to the drug or worsening of the condition being treated. Scrubbing the rash could cause further irritation and increase the risk for other infections. Continuing the drug could cause further complications. Decreasing the medication would be ineffective in treating the infection while continuing to risk further complications. It would be unnecessary to have clinical allergy testing prior to discontinuing the medication.

Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4, 5 Page and Header: 172, Introduction; 172, Box 11.1 10. The nurse admitted a client diagnosed with a systemic fungal infection. Before administering ketoconazole as prescribed, what should the nurse confirm? A) the client’s complete blood count (CBC) and white cell differential B) the client’s blood type C) the client’s height and weight D) the client’s hepatic function

Ans: D

Feedback: It would be important for the nurse to know the client’s CBC, height, and weight. All of these factors could help determine a specific dosage. However, the most important factor would be the client’s hepatic function because hepatotoxicity could occur quickly if the liver is not functioning properly. There is no obvious need to know the client’s blood type.

Format: Multiple Choice

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Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 172, Azole Antifungals; 173, Table 11.1 11. A client has just been prescribed fluconazole 400 mg PO for today, followed by 100 mg PO daily for 2 days. The nurse recognizes which medical diagnosis is likely? A) tinea capitis B) cryptococcal meningitis C) histoplasmosis D) vaginal candidiasis

Ans: D

Feedback: Fluconazole is available for oral use and is effective in treating Candida albicans. It is also used for cryptococcal meningitis, but this would necessitate a longer course of IV administration. Fluconazole is not used to treat histoplasmosis or tinea capitis.

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B) Apply the medication using sterile technique. C) Administer the drug high into the vagina. D) Insert a tampon after insertion to help retain the drug.

Ans: C

Feedback: Vaginal antifungals should be administered high into the vagina. The client should be placed in a recumbent position for insertion. Clean technique (not sterile) should be used. Inserting a tampon after administration is not necessary.

Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 172, Systemic Antifungals; 173, Table 11.1 13. The nurse is caring for a client who has been diagnosed with aspergillosis and has been prescribed amphotericin B. What action should the nurse perform before administering this medication? A) Establish intravenous access. B) Assess the integrity of the client’s mucous membranes. C) Assess the client’s skin integrity. D) Assist the client into a supine position.

Ans: A

Feedback: Amphotericin B is only administered by the IV route, so the nurse must ensure reliable IV access. The condition of the client’s skin and mucous membranes is unrelated to the use of amphotericin B. There is no specific need to position the client supine.

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Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 172, Azole Antifungals 14. A client in the intensive care unit has been diagnosed with cryptococcosis, and amphotericin B has been prescribed. What should the nurse do in order to prevent or minimize adverse reactions to this medication? A) Administer benzodiazepines as prescribed. B) Administer antipyretics as prescribed. C) Apply barrier cream to rashes. D) Administer diuretics as prescribed.

Ans: B

Feedback: Amphotericin B is often given with antipyretics to improve client comfort and to minimize adverse reactions. Rashes are not anticipated, and there is no indication for diuretic use. Benzodiazepines would likely exacerbate the CNS effects of the drug.

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15. The critical care nurse is providing care for a client who is being treated with amphotericin B. When assessing for potential adverse effects, what assessments should the nurse perform? Select all that apply. A) Monitor the client’s blood glucose levels. B) Assess for jaundice and monitor liver enzyme levels. C) Monitor urine output and BUN and creatinine levels. D) Assess for nausea and vomiting. E) Assess skin integrity at the client’s IV site.

Ans: B, C, D, E

Feedback: Amphotericin B is nephrotoxic and hepatotoxic so the nurse must assess for kidney or liver damage. Other risks of amphotericin B include bone marrow suppression; GI irritation with nausea, vomiting, and potentially severe diarrhea; anorexia and weight loss; and pain at the injection site with the possibility of phlebitis or thrombophlebitis. Hyperglycemia and hypoglycemia are not among its many adverse effects, however.

Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 172, Azole Antifungals 16. The nurse is reviewing the client’s medication regimen and sees fluconazole has been prescribed. The nurse recognizes that they should question the health care provider if the client is also taking which medication? A) digoxin B) humulin insulin C) acetaminophen D) hydrochlorothiazide

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Ans: A

Feedback: Fluconazole strongly inhibits the cytochrome P-450 (CYP450) enzyme system in the liver and is associated with many drug–drug interactions, such as increased serum levels of the following agents: cyclosporine, digoxin, oral hypoglycemics, warfarin, oral anticoagulants, and phenytoin. Diphenhydramine, acetaminophen, and hydrochlorothiazide have no impact on fluconazole. There is no indication that humulin insulin, acetaminophen, and hydrochlorothiazide are contraindicated when taking fluconazole.

Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 176, Other Antifungal Agents 17. The nurse administers nystatin to a client diagnosed with oral candidiasis. The nurse should understand that this medication achieves a therapeutic effect by what means? A) changing membrane permeability B) preventing reproduction of fungal cells C) causing mutation D) inhibiting glucan synthesis

Ans: A

Feedback: Nystatin binds to sterols in the cell wall, changing membrane permeability and allowing leaking of the cellular components, which will result in cell death. Nystatin is not a fungistatic (prevents reproduction of fungal cells), and it does not inhibit glucan synthesis.

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Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 5 Page and Header: 178, Topical Antifungals; 179, Table 11.2 18. The nurse teaches the client to self-administer tioconazole for a vaginal candidal infection. What instructions should the nurse provide? A) “Fill the applicator with the medication and insert it into the vagina at bedtime.” B) “Apply the medication to the perineal area twice a day and wear white cotton underwear.” C) “Soak in a sitz bath twice daily and insert the medication into the vagina after the bath.” D) “Take one tablet by mouth and be sure to follow the medication with a full glass of water.”

Ans: A

Feedback: Tioconazole is a vaginal ointment meant for one-dose treatment only; one applicator full of ointment is inserted vaginally at bedtime. Using the medication at bedtime helps decrease losing the medication by gravity and extends the time the medication will be in contact with the vaginal wall. The medication is not usually applied to the perineum unless the infection has traveled outside the vagina. Sitz baths are contraindicated because fungi flourish in moist environments. This medication is not administered orally and can only be applied topically.

Format: Multiple Choice Chapter: 11

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 178, Topical Antifungals; 179, Table 11.2 19. A client reports vaginal itching and burning which the provider believes to be caused by a candidal infection. What medication may offer the client relief after a single dose? A) caspofungin B) terbinafine C) ketoconazole D) tioconazole

Ans: D

Feedback: Tioconazole may be given as one dose for treatment of vaginal candidal infection. Caspofungin is given IV to treat invasive aspergillosis in clients who did not respond to other treatments and would not be used for a vaginal candidal infection. Terbinafine is administered twice daily for 1 to 4 weeks to treat topical mycosis. Ketoconazole is administered orally or topically to treat aspergillosis, leishmaniasis, cryptococcosis, blastomycosis, moniliasis, coccidioidomycosis, histoplasmosis, and mucormycosis but would not be used to treat vaginal candidal infections.

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20. The nurse works on a renal transplant unit and is caring for a client who has just been prescribed posaconazole. The nurse should assess the client for signs and symptoms of what infection? A) blastomycosis B) aspergillosis C) mucormycosis D) coccidioidomycosis

Ans: B

Feedback: Posaconazole is used for prophylaxis treatment of invasive Aspergillus and Candida infections in adults and children older than 13 years who are immunosuppressed secondary to antineoplastic, chemotherapy, graft versus host disease following transplants or hematological malignancies. Posaconazole would not be used to treat blastomycosis, mucormycosis, or coccidioidomycosis.

Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 172, Systemic Antifungals 21. The nurse admits a client diagnosed with a systemic fungal infection and who has been prescribed IV fluconazole. When developing the plan of care for this client, the nurse should assess for what nursing diagnosis related to this medication? A) chronic pain related to the gastrointestinal (GI) system, central nervous system (CNS), and local effects of drug B) risk for altered tissue perfusion secondary to system cardiovascular effects of drug C) altered sensory perception (kinesthetic) related to CNS effects D) hyperthermia related to hypothalamic stimulation

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Ans: C

Feedback: Nursing considerations related to drug therapy with IV fluconazole might include disturbed sensory perception (kinesthetic) related to CNS effects. Cardiovascular effects are not a concern with this medication; acute, not chronic, pain is associated with GI, CNS, and local effects of the drug. Hyperthermia is not a likely adverse effect.

Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 172, Azole Antifungals 22. The nurse is caring for a client receiving fluconazole to treat a systemic fungal infection. What should the nurse include in the client’s plan of care? A) Maintain complete bed rest until adverse effects are ruled out. B) Assess for peripheral cyanosis every 4 hours. C) Administer medication with probiotics. D) Monitor nutritional status.

Ans: D

Feedback: Monitor nutritional status and arrange a dietary consultation as needed to ensure nutritional status secondary to gastrointestinal (GI) upset related to medication. Complete bed rest is unnecessary. Cyanosis is not an anticipated problem. Probiotics are not commonly ordered along with antifungals.

Format: Multiple Selection

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Chapter: 11 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching and Learning Objective: 1 Page and Header: 172, Introduction 23. An experienced nurse has observed that fungal infections are more common than in previous decades. The nurse should identify which factor(s) as having led to this phenomenon? Select all that apply. A) acquired immunodeficiency syndrome (AIDS)-related complex B) increased incidence and prevalence of cancer C) rise in birth rates across the country D) greater number of older adults E) increased use of immunosuppressant people

Ans: A, D, E

Feedback: The incidence of fungal infections has increased with the rising number of immunocompromised people—clients with AIDS and AIDS-related complex (ARC), those taking immunosuppressant drugs, those who have undergone transplantation surgery or cancer treatment, and members of the increasingly larger older population, who are no longer able to protect themselves from the many fungi that are found throughout the environment. Cancer rates and birth rates are declining and do not contribute to the increase in diagnosis of fungal infection.

Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process

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Objective: 2 Page and Header: 172, Azole Antifungals 24. A client who has received a heart transplant is taking cyclosporine. The client is found to have a systemic Aspergillus infection. What drug should the nurse question if ordered for this client? A) terbinafine B) posaconazole C) itraconazole D) ketoconazole

Ans: D

Feedback: Ketoconazole and fluconazole strongly inhibit the cytochrome P-450 (CYP450) enzyme system in the liver and is associated with many drug–drug interactions such as increased serum levels of cyclosporine. There is no obvious contraindication between the use of cyclosporine and itraconazole, posaconazole, and terbinafine.

Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 176, Echinocandin Antifungals; 173, Table 11.1 25. The nurse is caring for a client diagnosed with a secondary immunodeficiency disease following kidney transplantation. The client has developed candidemia. The nurse should anticipate receiving an order for what medication? A) amphotericin B B) anidulafungin C) flucytosine D) butoconazole

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Ans: B

Feedback: Anidulafungin is used for the treatment of candidemia (infection of the bloodstream) and other forms of candidal infections, intra-abdominal infections, and esophageal candidiasis. Amphotericin B is not indicated in the treatment of candidemia. Flucytosine is indicated for the treatment of candidemia but is excreted primarily in the urine so would be contraindicated in a client with a transplanted kidney. Butoconazole is a topical medication that would not be appropriate for treating a systemic bloodborne fungal infection.

Format: Fill-in-the-blank Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 176, Echinocandin Antifungals; 173, Table 11.1 26. The nurse is caring for a client who has been diagnosed with invasive aspergillosis. The client has been prescribed voriconazole 6 mg/kg IV q12h for two doses then 4 mg/kg IV q12h. The client weighs 165 lbs. How many mg of voriconazole should the nurse administer when giving the client’s first dose?

Ans: 450 mg.

Feedback: First, convert the client’s weight to kg: 165 lbs ÷ 2.2 = 75 kg. The first dose should be 6 mg/kg, and 6 mg × 75 kg = 450 mg.

Format: Multiple Choice Chapter: 11

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 178, Topical Antifungals; 179, Table 11.2 27. The nurse in a long-term care facility is caring for a client who has developed oropharyngeal candidiasis. What medication is the nurse most likely to administer? A) itraconazole B) amphotericin B C) posaconazole D) clotrimazole

Ans: D

Feedback: Clotrimazole is an effective treatment for oropharyngeal candidiasis (in troche form) or to prevent oropharyngeal candidiasis in clients receiving radiation or chemotherapy. Itraconazole, amphotericin B, and posaconazole would not be appropriate for this client because they do not normally treat oropharyngeal candidiasis infections.

Format: Multiple Selection Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 172, Introduction; 172, Box 11.1 28. The nurse is caring for a 92-year-old client who has a fungal infection. The client’s plan of care should likely include what actions related to administration of any antifungal medications? Select all that apply. A) lower doses than younger adult clients

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B) frequent monitoring of health status C) frequent testing of liver function D) shorter course of treatment than younger clients E) continuous cardiorespiratory monitoring

Ans: A, B, C

Feedback: Older adults are at increased risk for some liver dysfunction and require more careful monitoring, lower dosages, and frequent assessment of liver function studies. Course of treatment should not be shortened, but dosage must often be reduced. Continuous cardiorespiratory monitoring is not indicated.

Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 172, Azole Antifungals; 175, Box 11.2 29. A 15-year-old client is immunocompromised because of the adverse effects of chemotherapy. The client has developed severe migraine headaches and is being treated with ergot. What drug would be contraindicated in this client? A) caspofungin B) ketoconazole C) posaconazole D) terbinafine

Ans: C

Feedback: Clients being treated with voriconazole or posaconazole should be cautioned about the risk of ergotism if they combine this drug with ergot, an herb frequently used

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to treat migraine headache and menstrual problems. If the client is using voriconazole, it should be suggested that ergot not be used until the antifungal therapy is finished. The other options do not have a known drug interaction with ergot.

Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Understand Difficulty: Easy Integrated Process: Communication and Documentation Objective: 1 Page and Header: 172, Introduction 30. When reviewing the client’s health record, the nurse reads that the client has been treated for mycosis in the past. The nurse recognizes that the client has had which type of infection? A) an infection caused by a fungus B) a cutaneous fungal infection C) a systemic fungal infection D) a fungal infection with a secondary bacterial infection

Ans: A

Feedback: A mycosis is simply a fungal infection. It does not give any indication of type or where it is found and is unrelated to a bacterial infection.

Format: Multiple Selection Chapter: 11 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 5 Page and Header: 172, Systemic Antifungals 31. The nurse admits a client suspected of having a fungal infection. What action(s) should the nurse take before administering a systemic antifungal? Select all that apply. A) Initiate IV therapy. B) Assess history of liver or kidney disease. C) Obtain a culture of the fungus. D) Request the client sign a consent form. E) Assess history of lymphatic disease.

Ans: B, C

Feedback: The nurse would assess the client for history of liver or kidney disease because systemic antifungals carry a higher risk of adverse effects and toxicity in clients with disease of these organs. A culture to determine the type of fungus should also be performed to increase the likelihood of the correct medication being prescribed. Not all antifungals are administered IV so this may not be necessary and would not be initiated until a drug was prescribed. A consent form related to the use of a particular drug is not needed by most facilities, and obtaining informed consent is not normally a nursing responsibility. A history of lymphatic disease would not be associated with concern related to antifungal medications.

Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 172, Azole Antifungals; 173, Table 11.1

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32. The client is admitted for IV administration of antifungal medication with the plan to discharge the client on oral medication in a few days. What medication would be most appropriate if it must be available by both IV and PO routes? A) fluconazole B) itraconazole C) posaconazole D) terbinafine

Ans: A

Feedback: Fluconazole and voriconazole are available in oral and IV preparations, making it possible to start the drug IV for a serious infection and then switch to an oral form when the client’s condition improves and they are able to take oral medications. Itraconazole, posaconazole, and terbinafine are administered only orally.

Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 172, Azole Antifungals; 173, Table 11.1 33. A client with candidiasis has just been prescribed fluconazole 400 mg PO. What is the nurse’s best action upon receiving this prescription? A) Administer the medication once it is received from the pharmacy. B) Contact the provider to confirm the medication dose. C) Contact the provider to confirm the medication route. D) Administer the medication, provided the client has an empty stomach.

Ans: A

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Feedback: This prescription is within ranges for indication, dose, and route. There is no obvious reason for the nurse to withhold administration. Fluconazole can be taken with or without food; taking it with food often minimizes GI upset.

Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 172, Azole Antifungals; 175, Box 11.2 34. The nurse is assessing the client’s medication history and learns that the client received a prescription for voriconazole from one provider and a prescription for an ergot alkaloid from another provider. The nurse should realize that this client is at risk for, and should be assessed for, what condition? A) liver toxicity B) central nervous system (CNS) depression C) ergotism D) renal toxicity

Ans: C

Feedback: This client is at risk for ergotism and would require an electrocardiographic or rhythm strip to assess the QT interval because ergotism manifests with prolonged QT intervals. The drug combination does not contribute to hepatic or renal toxicity or depression of the central nervous system.

Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 176, Other Antifungal Agents; 176, Box 11.3 35. A client has been newly prescribed terbinafine. Which prescription identified in the client’s current medication history would create an increased risk for name confusion when considering brand names? A) Lotrimin B) Luzu C) Lamictal D) Loprox

Ans: C

Feedback: Name confusion has occurred between the brand names Lamisil (terbinafine) and Lamictal (lamotrigine, an antiepileptic agent). Use extreme caution if your client is receiving either of these drugs to make sure that the correct drug is being used. None of the remaining options, luliconazole (Luzu), clotrimazole (Lotrimin), and ciclopirox (Loprox), share the name similarity of Lamisil to Lamictal.

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B) amphotericin B C) terbinafine D) flucytosine

Ans: A

Feedback: Clients with hepatic dysfunction are at increased risk for worsening hepatic problems and toxic effects of many of these drugs (ketoconazole, itraconazole, and griseofulvin). Other agents are associated with renal toxicity (amphotericin B, flucytosine, and griseofulvin); these should be used cautiously in the presence of renal impairment. Terbinafine is a nonazole antifungal that blocks the formation of ergosterol.

Test Generator Questions, Chapter 12, Antiprotozoal Agents Format: Multiple Choice Chapter: 12 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 187, Malaria 1. The client is having an acute malarial attack accompanied by chills and fever. The client’s chills and fever are the result of what pathophysiological process? A) formation of sporozoites within the vascular system B) rupture of red blood cells due to invasion of merozoites C) increased reuptake of dopamine in synaptic clefts D) release of amastigotes into the blood vessels

Ans: B

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Feedback: The chills and fever associated with an acute malarial attack are caused by the rupture of red blood cells containing merozoites. These symptoms are related to the pyrogenic effects of the protozoa and the toxic effects of the red blood cell components on the system. Dopamine levels are unrelated to these effects. The formation of sporozoites occurs in the stomach of the mosquito when the male and female gametocytes mate and produce a zygote. The release of amastigotes occurs in leishmaniasis, which is caused by the sand fly and is part of a cyclic pattern that causes serious skin lesions.

Format: Multiple Choice Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 189, Antimalarials; 192, Box 12.4 2. The nurse is caring for a client of Greek descent who plans to travel to an area of the world in which malaria is endemic. What should the nurse do before administering antimalarial medications? A) Assess the client for a history of Tay–Sachs disease. B) Confirm whether the client has been tested for glucose-6-phosphate dehydrogenase (G6PD) deficiency. C) Assess the client for any family history of sickle cell anemia. D) Confirm the client’s allergy status, with particular concern for penicillins.

Ans: B

Feedback: Clients of Mediterranean descent, including Greeks, are more likely to have a G6PD deficiency. When clients with this deficiency take primaquine, chloroquine, or quinine, an acute hemolytic crisis may occur. Clients of Mediterranean descent should be tested for G6PD deficiency before any antimalarial drugs are prescribed. Tay–Sachs

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disease is a disorder seen in those of middle-eastern descent that causes death of the child by age 5. Sickle cell disease and penicillin allergy have no connection to this situation.

Format: Multiple Choice Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 189, Antimalarials 3. The nurse is caring for a client who is being treated with high doses of quinine for drug-resistant malaria. What assessment findings should suggest to the nurse that the client may have cinchonism? A) diarrhea, nausea, and fever B) yellowing of the sclera and skin C) tremors and ataxia D) vomiting, tinnitus, and vertigo

Ans: D

Feedback: Clients with cinchonism or quinine toxicity may complain of tinnitus, headache, dizziness, nausea, fever, tremors, and visual disturbances. Diarrhea, yellowing of the sclera or skin, and ataxia are not associated with cinchonism.

Format: Multiple Choice Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Teaching/Learning Objective: 5 Page and Header: 189, Antimalarials 4. A client who travels extensively has been receiving chloroquine for malaria prophylaxis for an extended time. What should the nurse teach the client? A) “You may be prone to fungal infections during treatment.” B) “You should have your eyes examined regularly.” C) “You should avoid getting any immunizations while taking chloroquine.” D) “You must avoid over-the-counter antacids.”

Ans: B Feedback: Chloroquine is associated with visual disturbances, and a client receiving this drug should receive regular ophthalmic examinations. Immunizations are not affected by chloroquine use. Antacids are not necessarily contraindicated, and the client’s risk of fungal infections is not increased.

Format: Multiple Choice Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 189, Antimalarials 5. The nurse is writing a plan of care for a client receiving antimalarial drug therapy. What nursing conclusion would be appropriate if the client developed common adverse effects? A) disturbed sensory perception (visual) related to central nervous system effects B) imbalanced nutrition: more than body requirements C) constipation related to increased water absorption D) ineffective breathing pattern related to medullary suppression

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Ans: A

Feedback: Visual disturbances, including blindness related to retinal damage from the drug, may occur. Clients usually have gastrointestinal (GI) upset including diarrhea, not constipation, which could produce loss of weight and not an increase. Respiratory disturbances are not associated with antimalarial agents.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 194, Other Protozoal Infections 6. A nurse has provided care in numerous locations throughout the United States. What intestinal parasitic infection is the nurse most likely to encounter? A) amebiasis B) giardiasis C) leishmaniasis D) trichomoniasis

Ans: B

Feedback: The most commonly diagnosed intestinal parasite in the United States is giardiasis. It is transmitted through contaminated water or food. Amebiasis is found in the United States but is not the most common. Leishmaniasis is transmitted through sand flies, which are not common in the United States. Trichomoniasis is a flagellated protozoan and most often is seen in the vagina and is spread during sexual intercourse by men who have no signs and symptoms of infection; however, it is not an intestinal parasite.

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Format: Multiple Choice Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 195, Other Antiprotozoal Agents 7. A client has been diagnosed with trichomoniasis. Before beginning tinidazole therapy, what assessment should the nurse perform? A) assessing the client’s working conditions B) assessing the client’s use of alcohol C) assessing the client’s immunization status D) assessing whether the client has been tested for HIV

Ans: B

Feedback: Tinidazole is prescribed for trichomoniasis, which is transmitted during sexual intercourse. The drug should not be used when there is a history of alcohol use. Alcohol use could interfere with the drug’s metabolism in the liver and cause toxicity, and clients should be warned to avoid consuming all alcoholic beverages while taking this medication. There is no need to question about working conditions or immunizations. There may be a need for HIV testing because of the likely history of sexual transmission, but this does not affect tinidazole therapy.

Format: Multiple Choice Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process

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Objective: 4 Page and Header: 195, Other Antiprotozoal Agents; 196, , Table 12.2 8. The nurse is caring for a client with acquired immunodeficiency syndrome (AIDS) who has been diagnosed with Pneumocystis jiroveci pneumonia. The client is taking multiple oral agents to treat AIDS. What would be the drug of choice for this client’s pneumonia? A) nitazoxanide B) chloroquine C) metronidazole D) pentamidine

Ans: D

Feedback: Pentamidine is available as an inhalation product for the direct treatment of P. jiroveci in clients with AIDS. Because the client is already taking multiple oral drugs, inhaler administration would be the best choice. Nitazoxanide, chloroquine, and metronidazole are not effective against P. jiroveci pneumonia.

Format: Multiple Choice Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 3 Page and Header: 195, Other Antiprotozoal Agents 9. A female client diagnosed with giardiasis is being treated with metronidazole. What comment by the client should indicate that the nurse needs to provide further teaching? A) “I can continue to work delivering pizza because the disease is not contagious.” B) “I’m relieved that I won’t lose my hair during drug therapy.” C) “I know I will likely experience diarrhea during this time.” D) “I shouldn’t experience irregular menstrual periods.”

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Ans: A

Feedback: Although giardiasis is not contagious, the client should be encouraged not to drive or operate heavy equipment until the effects of the drug can be assessed because metronidazole can lead to central nervous system adverse effects, including dizziness and lack of coordination. The drug may also cause diarrhea. Loss of hair and irregular menstrual periods are not associated with this drug, so these statements would be correct and would not indicate the need for further teaching.

Format: Multiple Choice Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 3 Page and Header: 189, Antimalarials 10. The clinic nurse provides teaching for a client who has been prescribed pyrimethamine to prevent malaria. The nurse should instructor the client to notify the health care provider immediately if which signs and symptoms occur? A) diarrhea, fatigue, and weight loss B) insomnia and inflammation C) headache, nausea, and constipation D) anorexia and nausea

Ans: A

Feedback: If signs of folate deficiency develop, pyrimethamine will need to be discontinued so the prescriber needs to be notified immediately. Folate deficiency presents with diarrhea, fatigue, weight loss, and anemia. The other signs and symptoms would need to be reported if significant and/or long lasting.

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Format: Multiple Choice Chapter: 12 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 195, Other Antiprotozoal Agents 11. The mother of a 6-month-old infant presents to the clinic, and the mother is subsequently diagnosed with a protozoal infection. What would be a priority nursing assessment? A) whether the client is breastfeeding B) whether the client has a strong social support network C) whether the client is intending on becoming pregnant again D) whether the client experienced a postpartum hemorrhage

Ans: A

Feedback: Assess for lactation because antiprotozoal drugs could enter the breast milk and be toxic to the infant. The other options are part of a complete nursing history but do not specifically relate to treatment for a protozoal infection.

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12. A client is prescribed mefloquine for malaria prophylaxis prior to a trip to rural Southeast Asia. When should the nurse instruct the client to begin taking the prescribed mefloquine? A) one week prior to travelling B) 24 to 48 hours prior to traveling C) upon arrival in Southeast Asia D) as soon as mosquitoes are noticed

Ans: A

Feedback: Mefloquine should be taken 1 week prior to entering a malarial area.

Format: Multiple Choice Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Easy Integrated Process: Teaching/Learning Objective: 2 Page and Header: 195, Other Antiprotozoal Agents 13. The nurse is providing health education to a client who was prescribed metronidazole. The nurse recognizes that the client understood the teaching when the client makes which statement? A) “I will refrain from driving while I am taking this medication.” B) “I will avoid foods high in vitamin C such as fresh citrus fruits.” C) “I will not drink alcohol while I am taking this medication.” D) “I will contact my health care provider if I have a cold.”

Ans: C

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Feedback: Clients should avoid all forms of alcohol while taking metronidazole. Clients do not need to avoid driving or eating foods high in vitamin C. There is no need for the client to seek care if they get a cold.

Format: Multiple Choice Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 195, Giardiasis; 196, Table 12.2 14. The emergency room nurse is assessing a client who presents with malaise, diarrhea, and pale stool containing mucus. The nurse should anticipate the administration of what medication? A) quinine B) mefloquine C) metronidazole D) ceftriaxone

Ans: C

Feedback: Diarrhea, rotten-egg-smelling stool, and pale and mucous-filled stool are commonly seen with giardiasis. Metronidazole is among the treatment options for giardiasis. Quinine and mefloquine are used in the treatment of malaria, not giardiasis. Ceftriaxone is an antibiotic and would be ineffective against a protozoal infection.

Format: Multiple Choice Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 2 Page and Header: 195, Other Antiprotozoal Agents 15. A client is being treated for Pneumocystis carinii pneumonia with pentamidine. The nurse prioritizes which assessment parameter when assessing the client for adverse effects? A) liver function tests B) serum potassium C) daily blood pressure D) blood urea nitrogen (BUN) and creatinine

Ans: A

Feedback: Clients receiving antiprotozoal agents should be monitored regularly to detect any serious adverse effects. Liver function tests are of particular importance to determine the appropriateness of therapy and to monitor for toxicity. Serum potassium, BUN, and creatinine would indicate kidney damage, which is not normally a risk with this drug. Blood pressure is not indicated for this medication but is an early indicator of health deterioration and is usually included in all provisions of care.

Format: Multiple Choice Chapter: 12 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 194, Other Protozoal Infections 16. A client has just begun treatment for trichomoniasis. What should the nurse teach the client? A) “Make sure that you stay out of the sun, or at least use heavy sunscreen, until you’ve finished the treatment.”

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B) “It’s important that your sexual partners be treated as well.” C) “Wash your hands with soap and water, or use an alcohol-based handrub, often.” D) “You likely got this from inadvertently drinking some impure water.”

Ans: B

Feedback: Trichomoniasis is usually spread during sexual intercourse and men often have no symptoms. Women present with red, inflamed vaginal mucosa, itching, burning, and a yellowish green discharge. Women should be taught the importance of having their partners tested and treated simultaneously to prevent reinfection. The disease is not waterborne, and there is no risk of photosensitivity with treatment. Good hand hygiene is beneficial for everyone but is not directly related to this client’s diagnosis or treatment.

Ans: C Feedback: Chloroquine should be taken with meals to reduce gastrointestinal (GI) upset; small frequent meals may also reduce negative GI effects. Taking medications,

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any medication, with adequate amounts of water is generally a good practice but not specific to this medication. Acidic beverages pose no threat to the drug.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 187, Malaria 18. The nurse is caring for a client who returned from a vacation with malaria. The client likely was exposed to malaria when the infected mosquito injected which organisms? A) sporozoites B) gametocytes C) schizonts D) merozoites

Ans: A

Feedback: Gametocytes are sucked with the blood from an infected person by the mosquito. The gametocytes mate in the stomach of the mosquito and produce a zygote that goes through several phases before forming sporozoites (spore animals) that make their way to the mosquito’s salivary glands. The next person who is bitten by that mosquito is injected with thousands of sporozoites. Schizonts are the primary tissue organisms resulting from asexual cell division and reproduction after the sporozoites are introduced into the body. Merozoites are then formed from the primary schizonts.

Format: Multiple Selection Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 189, Antimalarials 19. The nurse is providing client teaching for a client who is taking antimalarial medication. The nurse should explain the need to report which signs and symptoms immediately? Select all that apply. A) anorexia B) pruritus (itchy skin) C) visional changes D) nausea E) tinnitus

Ans: C, E

Feedback: Visual changes including possible blindness, which could indicate retinal damage; loss of hearing or ringing in the ears, which could indicate central nervous system toxicity; and fever or worsening of condition, which could indicate a drugresistant strain or noneffective therapy. Loss of appetite and nausea are a common result of the gastrointestinal (GI) effects of the drug that the nurse should provide anticipatory guidance to teach the client how to maintain adequate nutrition, but the client does not need to report this unless it becomes serious or unmanageable. Pruritus is not expected.

Format: Multiple Choice Chapter: 12 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 194, Other Protozoal Infections

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20. The nurse is caring for a client who just returned from a trip to South America and was infected by the protozoan Trypanosoma cruzi. What body system assessment should the nurse prioritize when caring for this client? A) integumentary assessment B) neurologic assessment C) cardiac assessment D) genitourinary assessment

Ans: C

Feedback: Chagas disease, which is caused by T. cruzi, is passed to humans by the common house fly. This protozoan results in a severe cardiomyopathy that accounts for numerous deaths and disabilities in certain regions. Because of the risk of cardiomyopathy, cardiac assessment should be prioritized over neurologic, genitourinary, or integumentary assessment.

Format: Multiple Selection Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 189, Antimalarials 21. A client diagnosed with malaria is taking primaquine. The nurse recognizes which assessment findings may indicate that the client has cinchonism? Select all that apply. A) diarrhea B) abdominal cramping C) tan, frothy stool D) vertigo E) tinnitus

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Ans: D, E

Feedback: Cinchonism (nausea, vomiting, tinnitus, and vertigo) may occur with high levels of primaquine. Symptoms of cinchonism do not include diarrhea, abdominal cramping, or tan, frothy stool.

Format: Multiple Choice Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 189, Antimalarials 22. A client has been prescribed an antimalarial medication as prophylaxis for the disease. What should the nurse teach the client about expected adverse effects? A) “Most people experience an upset stomach when they’re taking this drug.” B) “If you get constipated, it’s okay to take an over-the-counter stool softener.” C) “You might find that the lining of your nose dries out more easily than normal.” D) “You’ll likely feel quite drowsy, so it’s best to take this at bedtime.”

Ans: A

Feedback: Nausea, vomiting, dyspepsia, and anorexia are associated with direct effects of the antimalarial medications on the GI tract. Diarrhea is more likely than constipation, and it is atypical for the client’s mucous membranes to dry out. Antimalarial medications do not usually cause drowsiness.

Format: Multiple Choice Chapter: 12 Client Needs: Physiological Integrity: Physiological Adaptation

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Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 187, Malaria 23. In the emergency department, a client recently returned from Africa reports a sudden onset of high fever and swelling and reddening of the limbs. Their blood pressure is 92/49 mm Hg. The nurse recognizes which protozoan would have caused the client’s suspected malaria? A) Plasmodium ovale B) Plasmodium falciparum C) Plasmodium vivax D) Plasmodium malariae

Ans: B

Feedback: Plasmodium falciparum is considered to be the most dangerous type of protozoan. Infection with this protozoan results in an acute, rapidly fulminating form of the disease with high fever, severe hypotension, swelling and reddening of the limbs, loss of red blood cells, and even death. The other options are pathogens that cause milder forms of the disease, and P. ovale is rarely encountered. Format: Multiple Choice Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 194, Other Protozoal Infections 24. Pyrimethamine has been ordered for the client as prophylactic treatment for malaria. By which mechanism of action does this drug prevent relapse of the disease? A) changing the metabolic pathways for reproduction B) disrupting the mitochondria of the plasmodium

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C) blocking the use of folic acid D) increasing the acidity of plasmodial food vacuoles

Ans: C

Feedback: Pyrimethamine is used in combination with agents that act more rapidly to suppress malaria; it acts by blocking the use of folic acid in protein synthesis by the plasmodium, eventually leading to inability to reproduce and cell death. Chloroquine changes the metabolic pathways for reproduction of the plasmodium and is toxic to parasites that absorb it. Primaquine disrupts the mitochondria of the plasmodium. Mefloquine increases the acidity of plasmodial food vacuoles causing cell rupture and death.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 194, Other Protozoal Infections 25. A client, recently returned from a vacation in the tropics, is diagnosed with leishmaniasis. The nurse determines which assessment question is best when addressing the cause of the client’s health problem? A) “Were there many mosquitoes where you were visiting.” B) “Did you drink tap water at any time when you were away?” C) “Did you eat food from any outdoor street vendors during your trip?” D) “Do you recall there being any sand flies on your vacation.”

Ans: D

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Feedback: Leishmaniasis is a disease caused by a protozoan that is passed from sand flies to humans. It is not foodborne, waterborne, or transmitted by mosquitoes.

Feedback: African sleeping sickness, which is caused by Trypanosoma brucei gambiense, is transmitted by the tsetse fly. After the pathogenic organism has lived and grown in human blood, it eventually invades the central nervous system, leading to acute inflammation resulting in lethargy, prolonged sleep, and even death. G. lamblia causes giardiasis; T. cruzi causes Chagas disease. A promastigote is a flagellated protozoan that causes leishmaniasis.

Format: Multiple Choice Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate

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Integrated Process: Teaching/Learning Objective: 2, 4 Page and Header: 189, Antimalarials 27. A client is prescribed chloroquine and asks the nurse how it works. What process should the nurse describe? A) blocks the plasmodium’s ability to synthesize ribonucleic acid B) changes the metabolic pathways necessary for the reproduction of the plasmodium C) interrupts the cell wall preventing entry of nutrients into the plasmodium D) decreases the ability of the parasite to synthesize deoxyribonucleic acid (DNA) because it is alkaline

Ans: B

Feedback: Chloroquine is currently the mainstay of antimalarial therapy. This drug enters human red blood cells and changes the metabolic pathways necessary for the reproduction of the plasmodium. In addition, this agent is directly toxic to parasites that absorb it, it is acidic, and it decreases the ability of the parasite to synthesize DNA, leading to a blockage of reproduction.

Format: Multiple Choice Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 189, Antimalarials; 190, Table 12.1 28. A client who will soon leave on a trip to a tropical rainforest is prescribed chloroquine 300 mg PO daily for prophylaxis of malaria. What is the nurse’s best action when receiving this prescription? A) Review the client’s BUN and creatinine levels, if available. B) Review the client’s liver enzyme levels, if available.

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C) Confirm the route with the prescriber. D) Confirm the frequency with the prescriber.

Ans: D

Feedback: Usual doses for prophylaxis of malaria using chloroquine are 300 mg PO weekly, not daily. Addressing this discrepancy would be a priority over physical assessment.

Format: Multiple Choice Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 189, Antimalarials 29. The nurse admits a pediatric client who will be traveling to a country where malaria is endemic. The family is seeking information about prophylaxis for the country where they are visiting. What is the nurse’s best action? A) Explain that no prophylaxis is administered to children under 16 because adverse effects outweigh benefits. B) Get information from the Centers for Disease Control and Prevention (CDC) about the safest and most effective treatment. C) Refer the family to their health care provider since doses for antimalarial prophylaxis are not age dependent. D) Encourage the family to reconsider their decision to bring their child to an area where malaria is endemic.

Ans: B

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Feedback: Although dosages for prophylaxis have been calculated to treat malaria in children, many drugs have not been proven to be safe and efficient in that population and extreme caution is needed. If a child needs to travel to an area with endemic protozoal infections, the CDC or local health department should be consulted about the safest possible preventive measures. Prophylaxis is a possibility. As with all drugs, doses are age dependent. The nurse should provide education about risks of travel, as they know them, but it is not the nurse’s role to ask them to reconsider their decision.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Understand Difficulty: Easy Integrated Process: Communication and Documentation Objective: 1 Page and Header: 187, Malaria 30. The nurse is providing health education about malaria to a traveler who has been prescribed chloroquine. What statement by the client demonstrates an accurate understanding of the epidemiology of malaria? A) “Malaria can live without a host and be contracted from drinking standing water.” B) “Any mosquito can carry the plasmodium that transmits malaria.” C) “A major problem with controlling malaria is the mosquito that is resistant to insecticide.” D) “Widespread efforts at mosquito control have never been successful.”

Ans: C

Feedback: Widespread efforts at mosquito control have been successful, with fewer cases of malaria being reported each year. However, the rise of insecticide-resistant mosquitoes has allowed malaria to continue to flourish, increasing the incidence of the disease. Malaria requires a host to live, whether it is human or mosquito. Only the female Anopheles mosquito harbors the protozoal parasite and carries it to humans.

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Format: Multiple Selection Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 194, Other Protozoal Infections 31. The nurse is caring for a client diagnosed with amebiasis caused by Entamoeba histolytica that resulted in the client having amebic dysentery. What questions should the nurse ask in an attempt to discover how the client came in contact with the organism? Select all that apply. A) “Have you traveled outside the country recently?” B) “Have you been swimming in a lake or pond recently?” C) “Have you been eating fresh fruits or vegetables without washing them first?” D) “Have you been bitten by a mosquito?” E) “Have you had unprotected sex recently?”

Ans: A, B, C

Feedback: The disease is transmitted while the protozoan is in the cystic stage in fecal matter, from which it can enter water and soil. It can be passed to other humans who drink this water or eat food that has been grown in this ground. It is not passed by a mosquito or from sexual activity.

Format: Multiple Selection Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 3, 4 Page and Header: 195, Other Antiprotozoal Agents; 196, Table 12.2 32. A newly admitted client has a protozoal infection, and the client’s current medication regimen includes metronidazole. What medical diagnoses may this client have? Select all that apply. A) trichomoniasis B) giardiasis C) amebiasis D) Pneumocystis carinii pneumonia E) Cryptosporidium parvum

Ans: A, B, C

Feedback: Metronidazole and tinidazole are effective treatments for trichomoniasis, giardiasis, and amebiasis. They are not effective for P. carinii pneumonia or C. parvum.

Format: Multiple Choice Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 187, Box 12.1, Antiprotozoal Agents 33. How should the nurse adapt the plan of care when caring for an older adult receiving an antiprotozoal agent? A) Clients should be monitored more closely for toxic adverse effects. B) The drug dosage should be lowered for all older adults. C) Antiprotozoal agents should not be administered to older adults. D) Female clients of appropriate age should be advised to use barrier contraceptives to prevent genitourinary infections.

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Ans: A

Feedback: Older clients may be more susceptible to the adverse effects associated with these drugs. They should be monitored closely. Dosage should only be lowered if the client has hepatic dysfunction or if hepatic dysfunction is anticipated. Antiprotozoal agents can be administered to older adults with caution when the benefit outweighs the risk. It is not necessary for older adult women to use barrier methods of contraceptives because they are no longer of childbearing age.

Format: Multiple Selection Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 189, Antimalarials; 194, Box 12.5 34. A client had been discussing the use of hydroxychloroquine for COVID-19 treatment with the nurse. The nurse shares that the FDA has given approval to prescribe this medication for the treatment of which condition? Select all that apply. A) rheumatoid arthritis B) lupus erythematosus C) giardiasis D) trichomoniasis E) Malaria

Ans: A, B, E

Feedback: Hydroxychloroquine sulfate has been approved by the FDA to prevent and treat malaria as well as for treatment of lupus erythematosus and rheumatoid arthritis. Its mechanism of action for modulating inflammation and immune response and for

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acting against the Plasmodium causing malaria is not completely understood. Due to its effectiveness for the above indications, some people believed that hydroxychloroquine and/or the similar medication chloroquine would be helpful for treatment of coronavirus 2019 disease (COVID-19). After many “off-label” uses and both animal and human studies, hydroxychloroquine and chloroquine were not found to reduce mortality of hospitalized clients with COVID-19. In fact, they were associated with more harm, especially in high doses and when used with other antiinfective medications. Giardiasis and trichomoniasis are both protozoal infections treated with antiprotozoals.

Format: Multiple Selection Chapter: 12 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 189, Antimalarials; 194, Box 12.5 35. A client diagnosed with COVID-19 has shared that they have been taking high doses of hydroxychloroquine to manage their symptoms. What health condition will the nurse be prepared to assess regularly? Select all that apply. A) a prolonged QT interval B) peptic ulcer C) heart block D) pulmonary fibrosis E) cardiac arrhythmias

Ans: A, B, E

Feedback: After many “off-label” uses and both animal and human studies, hydroxychloroquine and chloroquine were not found to reduce mortality of hospitalized clients with COVID-19. In fact, they were associated with more harm, especially in high doses and when used with other antiinfective medications, due to risk of QT prolongation

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and cardiac arrhythmias (including a heart block). Hydroxychloroquine is not known to cause either peptic ulcers or pulmonary fibrosis.

Test Generator Questions, Chapter 13, Anthelmintic Agents Format: Multiple Choice Chapter: 13 Client Needs: Health Promotion and Maintenance Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 204, Pinworm Infections 1. A public health nurse is educating school nurses about worm infections. The public health nurse should teach the school nurses to expect to encounter what type of worm infection most often? A) pinworms B) roundworms C) threadworms D) whipworms

Ans: A

Feedback: The most common worm infection encountered in U.S. school-aged children is pinworms. These worms are endogenous to the area and easily spread. Roundworms, whipworms, and threadworms are not as common.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 209, Anthelmintics; 210, Box 13.2 2. A 3-year-old child is diagnosed with pinworms. The nurse plans to educate the child’s parent about the use of what drug available in chewable form? A) pyrantel B) ivermectin C) mebendazole D) albendazole

Ans: C

Feedback: Mebendazole is the most commonly used anthelmintic for pinworms because it is available in a chewable tablet. This is a good choice for the 3-year-old client. Pyrantel is also prescribed for pinworms but is not available in a chewable form. Ivermectin is prescribed for treatment of threadworm disease, and albendazole is given to treat active lesions caused by pork tapeworm and cystic disease of the liver, lungs, and peritoneum caused by dog tapeworm.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 209, Anthelmintics 3. A client diagnosed with roundworms is prescribed albendazole. What assessment should the nurse perform to ensure safe and effective use of this medication? A) Assess whether the client is currently taking cimetidine. B) Assess the client’s suitability for insertion of a central IV catheter.

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C) Assess the client’s immunization status. D) Assess whether the client has taken loperamide in the past 48 hours. Ans: A

Feedback: The adverse effects of albendazole, which are already severe, may increase if the drug is combined with dexamethasone, praziquantel, or cimetidine. Loperamide is an antidiarrheal drug that may be used for treatment of diarrhea as a result of the mebendazole and pyrantel. The client’s immunization status will not have a major effect on the course of treatment. Albendazole is given orally, not intravenously.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 209, Anthelmintics 4. The nurse is providing care for a client who is prescribed albendazole. What assessment should the nurse prioritize? A) temperature, heart rate, and oxygen saturation B) daily weights and abdominal girth C) monitoring urine output, BUN, and creatinine D) assessing the client’s protein intake

Ans: C

Feedback: It is important that the client’s kidney function be monitored because a serious adverse effect of this drug is renal failure. Even though vital signs, weight, and nutrition are important and should be monitored, if the client exhibits any signs of renal failure, the drug should be stopped immediately.

Format: Multiple Choice

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Chapter: 13 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 205, Nursing Care Guide for J.K. Pinworm Treatment 5. The nurse is caring for an adult client receiving a prescription for an anthelmintic drug. The nurse should assess for which nursing conclusion? A) constipation B) altered body image perception related to diagnosis and treatment C) acute confusion D) imbalanced nutrition: more than body requirements

Ans: B

Feedback: A potential nursing conclusion for the client would be altered body image perception related to diagnosis and treatment. There is a definite stigma associated with having helminthic infections. Treatment can cause diarrhea, loss of hair, and pruritus, which could be noticed by others and further impact the client’s body image and identity. Usually these drugs do not cause constipation; they have not been linked to confusion.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 213, Summary 6. A nurse is teaching a client who has been diagnosed with trichinosis. The nurse should teach the client what aspect of this infection?

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A) This roundworm disrupts the host’s normal cellular functions, causing cell death and resulting in disease. B) Trichinosis invades body tissues and seriously damages lymphatic tissue, lungs, the central nervous system, the heart, and the liver. C) Trichinosis roundworms are exposed to the delicate mucous membranes of the anus and colon, producing local irritation. D) Trichinosis is easily passed from one individual to another resulting in rapid spreading within a work place.

Ans: B

Feedback: Trichinosis is a disease caused by the ingestion of the encysted larvae of the roundworm from undercooked pork. These worms exist outside the intestinal tract and can seriously damage the tissues they invade. The worms do not spread rapidly through a large group of people unless they have all eaten the undercooked pork. They do not enter cells to alter human cellular function. Damage far exceeds local irritation.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 212, Nursing Considerations for Patients Receiving Anthelmintics 7. A client has been diagnosed with a helminthic infection and has begun treatment with mebendazole. What should the nurse include in client education? A) Any person who was recently exposed to the client should receive prophylactic. B) The drug should be taken on an empty stomach to maximize therapeutic effect. C) The client should remain isolated until the course of mebendazole is complete. D) Strict hygiene measures are important in eradicating the infection.

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Ans: D

Feedback: When treating a client with an anthelmintic drug, the client should be instructed to follow strict handwashing and hygiene measures as an adjunct in eradicating the worm. Isolation is not necessary, and prophylactic treatment is not effective with worms. Anthelmintics are often taken with food to decrease the gastrointestinal (GI) adverse effects.

Format: Multiple Selection Chapter: 13 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 1, 5 Page and Header: 206, Hookworm Infections 8. The nurse is caring for a client diagnosed with hookworms and who is receiving mebendazole. When reviewing this client’s laboratory findings, what change(s) should the nurse attribute to the client’s infection? Select all that apply. A) increased bilirubin B) decreased hematocrit C) increased aspartate transaminase levels D) decreased blood glucose E) decreased hemoglobin

Ans: B, E

Feedback: Hookworms can cause anemia and fluid and electrolyte imbalances because of the amount of blood that is sucked from the walls of the intestine. A decreased hematocrit and hemoglobin would indicate anemia and is often found in clients with hookworm. Bilirubin and aspartate transaminase indicate liver function. Because mebendazole is not absorbed systemically, adverse effects are limited to abdominal

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effects such as discomfort, diarrhea, or pain so this drug would not impact bilirubin or aspartate transaminase levels. Neither the disease nor drug should decrease blood sugar.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 209, Anthelmintics 9. A client is taking an anthelmintic that is absorbed systemically. The nurse should caution the client about what possible adverse effect? A) urinary retention and cloudy urine B) constipation and abdominal pain C) headache and dizziness D) disturbances to hearing and vision

Ans: C

Feedback: Anthelmintics that are absorbed systemically could cause headache, dizziness, fever, shaking, chills, malaise, pruritus, and loss of hair. These drugs are not normally associated with the other listed adverse effects.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning

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Objective: 5 Page and Header: 206, Hookworm Infections 10. A parent brings a child to the clinic where the child is diagnosed with hookworms. The parent asks how the child got hookworms and how to prevent future occurrences. What should the nurse teach the parent to prevent future occurrences? A) Keep the child’s immunizations up-to-date. B) Ensure that the child wears shoes or sandals outdoors. C) Ensure that all food is cooked thoroughly to recommended temperatures. D) Practice vigilant hand hygiene.

Ans: B

Feedback: The hookworm larvae penetrate the skin and then enter the blood and, within about a week, reach the intestine. There is no vaccine available, and undercooked food does not cause hookworm infections. Hand hygiene has multiple health benefits, but hookworms nearly always enter the skin of the feet, not the hands.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 206, Ascaris 11. A client is diagnosed with an ascaris infection. The client asks what the best way is to prevent ascaris infections. What is the nurse’s best response? A) “Wash hands before eating.” B) “Do not share hairbrushes or hats.” C) “Wash fresh fruits and vegetables before eating.” D) “Avoid heavily populated areas.”

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Ans: C

Feedback: Ascaris infection occurs where sanitation is poor. Eggs in the soil are ingested with vegetables or other improperly washed foods containing the worm. The clients may be unaware until a worm in their stool is seen or the client becomes quite ill. Teaching clients the importance of washing fresh fruit and vegetables will help them reduce risk of infection. Washing hands, avoiding sharing hairbrushes or hats, and being aware in populated areas will reduce the risk of other infections but do not relate to ascaris.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 206, Cestodes 12. The nurse is providing care for a client who has just been diagnosed with a tapeworm. The nurse expects to identify which nursing conclusion? A) imbalanced nutrition: less than body requirements B) chronic pain C) constipation D) acute confusion

Ans: A

Feedback: Tapeworm affects the body’s ability to absorb food products and weight loss and malnutrition often follow unless treatment is received promptly. As a result, the best nursing diagnosis is imbalanced nutrition: less than body requirements. Clients with tapeworm are often symptom free but may experience some abdominal discomfort and

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distention as well as weight loss. They do not normally have chronic pain, constipation, or confusion.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 206, Tissue-Invading Worm Infections 13. Following a detailed diagnostic workup, a client has been diagnosed with schistosomiasis. What assessment question by the nurse best addresses the likely etiology of this client’s health problem? A) “Have you recently begun any new sexual relationships?” B) “When was the last time you traveled outside the country?” C) “Have you ever received a blood transfusion?” D) “Have you recently eaten any unpasteurized cheese or drunk unpasteurized milk?”

Ans: B

Feedback: People who come from or travel to areas of the world where schistosomiasis is endemic should always be assessed for the possibility of infection with such a disease when seen for health care. This disease is unrelated to sexual transmission, unpasteurized dairy products, or blood transfusions.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Remember Difficulty: Easy

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Integrated Process: Nursing Process Objective: 1 Page and Header: 206, Tissue-Invading Worm Infections 14. What helminthic infestation occurs in tropical areas and is carried by snails? A) schistosomiasis B) platyhelminthes C) trichinosis D) filariasis

Ans: A

Feedback: Schistosomiasis is a common problem in many tropical areas where the snail that is necessary in the life cycle of the fluke lives. Trichinosis is caused by eating undercooked pork and can occur in any part of the world. Filariasis and platyhelminthes are not restricted to tropical areas.

Ans: B

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Feedback: Filariasis refers to infection of the blood and tissues of healthy individuals by worm embryos, which enter the body via insect bites. These threadlike embryos, or filariae, can overwhelm the lymphatic system and cause massive inflammatory reactions. This may lead to severe swelling of the hands, feet, legs, arms, scrotum, or breast—a condition called elephantiasis. This does not occur with schistosomiasis, malaria, or tapeworms.

Format: Multiple Selection Chapter: 13 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 209, Anthelmintics 16. What anthelmintic(s) should the nurse expect to be readily absorbed from the client’s gastrointestinal (GI) tract? Select all that apply. A) mebendazole B) pyrantel C) albendazole D) praziquantel E) ivermectin

Ans: D, E

Feedback: Praziquantel and ivermectin are readily absorbed from the GI tract. Mebendazole, pyrantel, and albendazole are not.

Format: Multiple Choice Chapter: 13

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 4 Page and Header: 209, Anthelmintics; 210, Box 13.2 17. A parent brings their 18-month-old child into the clinic stating that they have been “scratching their bottom” for several days. Which medication should the nurse expect to be prescribed? A) pyrantel B) mebendazole C) ivermectin D) praziquantel

Ans: B

Feedback: Perianal itching is associated with pinworm infections, which are common among children. Mebendazole is available in the form of a chewable tablet that would be preferable for a young child with pinworms. Because little of the drug is absorbed systemically, it is safe for children and has few adverse effects, thus making it safer to administer to a child. Pyrantel is not approved for children younger than 2 years old. Ivermectin and praziquantel effects are systemic and would have a greater number of adverse effects.

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18. The nurse is caring for an adult client diagnosed with roundworms who is prescribed pyrantel. What should the nurse teach the client about potential adverse effects? A) “This drug is very effective, but make sure to get the ordered blood work done on schedule to monitor for side effects.” B) “If your skin is itchy during treatment, try using a moisturizing lotion.” C) “Some people get diarrhea or stomach pain, but overall, this doesn’t have many side effects.” D) “You might find yourself getting constipated, so it’s okay to take a stool softener.”

Ans: C

Feedback: Mebendazole and pyrantel, which are not absorbed systemically, may cause abdominal discomfort, diarrhea, or pain but have very few other effects and are well tolerated. Constipation and pruritus are unlikely, and there is no need for follow-up blood work related to possible adverse effects. Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 209, Anthelmintics 19. The nurse is caring for a client who has a tapeworm and who has been prescribed albendazole. When reviewing the client’s current medication regimen, what drug should cause the nurse to question administering albendazole? A) propranolol B) levothyroxine C) furosemide D) dexamethasone

Ans: D

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Feedback: The effects of albendazole, which are already severe, may increase if the drug is combined with dexamethasone, praziquantel, or cimetidine. These combinations should be avoided if at all possible; if they are necessary, clients should be monitored closely for occurrence of adverse effects. No contraindications are noted for propranolol, levothyroxine, or furosemide.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 4, 5 Page and Header: 209, Anthelmintics; 210, Table 13.2 20. An adult client is prescribed a 3-day course of mebendazole 100 mg PO each morning and evening to treat hookworms. What is the nurse’s best response to receiving this prescription? A) Contact the provider to question the dose. B) Ensure that the client’s renal and hepatic functions have been assessed. C) Contact the provider to question the frequency of administration. D) Confirm the client’s identity and administer the medication as prescribed.

Ans: D

Feedback: This prescription is within reference ranges for indication, drug, dose, route, and time. Mebendazole has comparatively few adverse effects; renal and hepatic testing is unnecessary before treatment for most clients.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Physiological Adaptation

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Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 206, Threadworm Infestation 21. The nurse is caring for a client diagnosed with threadworm infestation. What is the nurse’s priority assessment related to common manifestations of this infestation? A) mucous membrane integrity B) temperature and respiratory system C) urine output, BUN, and creatinine D) stool character and consistency

Ans: B

Feedback: Threadworm is a pervasive nematode that can send larvae into the lungs, liver, and central nervous system and can cause severe pneumonia or liver abscess. Because of the risk for pneumonia, the nurse should monitor the client’s respiratory function and assess for signs of infection. Renal damage is less likely, and respiratory function would be prioritized over mucous membrane integrity and bowel pattern.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 1 Page and Header: 206, Parent/Patient Teaching for J.K. 22. Diagnostic imaging of a client with an intestinal obstruction reveals that the obstruction is caused by adult worms clogging the lumen of the client’s intestine. The nurse should anticipate that this client will be diagnosed with which type of infection? A) platyhelminthes infection

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B) trichinosis C) Ascaris D) cestode infection

Ans: C

Feedback: Nematode are roundworms such as the commonly encountered pinworm, whipworm, threadworm, Ascaris, or hookworm that cause a common helminthic infection in humans and can cause intestinal obstruction as the adult worms clog the intestinal lumen or severe pneumonia when the larvae migrate to the lungs and form a pulmonary infiltrate. Trichinosis involves tissues, not the intestinal lumen. Cestodes such as tapeworms are not voluminous enough to obstruct the intestinal lumen. Platyhelminthes include cestodes and flukes, not nematodes.

Format: Multiple Choice Chapter: 13 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Moderate Integrated Process: Caring Objective: 5 Page and Header: 204, Introduction 23. The nurse is caring for a teenage client who has just been diagnosed with a tapeworm. What is a priority nursing action for this client? A) Monitor hepatic and renal function before, and periodically during, treatment. B) Provide small, frequent, nutritious meals if GI upset is severe. C) Instruct the client about OTC alternatives to the prescribed medication D) Offer support and encouragement.

Ans: D

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Feedback: Frequently, clients have a very difficult time dealing with a diagnosis of worm infestation. It is very important for the nurse to understand the disease process and to explain the disease and treatment carefully to help the client to cope with both the diagnosis and the treatment. Treatment for tapeworms is not highly nephrotoxic or hepatotoxic. A nurse never counsels a client toward alternatives to the prescribed drug regimen. GI management is important, but support is a priority.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 209, Anthelmintics 24. A client diagnosed with complex health issues has been prescribed ivermectin, in addition to several other medications. The nurse should recognize what implication for the client’s ivermectin therapy? A) Absorption will be delayed. B) Excretion will be impaired. C) Distribution will be inhibited. D) Metabolism will be delayed.

Ans: B

Feedback: Ivermectin is readily absorbed from the gastrointestinal (GI) tract and reaches peak plasma levels in 4 hours. It is completely metabolized in the liver with a half-life of 16 hours and excretion is fecal. For this reason, absence of bowel movements would constitute delayed excretion. Absorption, distribution, and metabolism would be largely unaffected.

Format: Multiple Choice

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Chapter: 13 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Easy Integrated Process: Nursing Process Objective: 4 Page and Header: 209, Anthelmintics 25. A client diagnosed with a tapeworm has been prescribed albendazole. What aspect of this client’s health history would cause delayed excretion? A) peripheral edema B) hepatitis A C) chronic renal failure D) viral pneumonia

Ans: C

Feedback: Albendazole is poorly absorbed from the GI tract, reaching peak plasma levels in about 5 hours. It is metabolized in the liver and primarily excreted in urine. Because it is excreted in the urine, renal failure would inhibit this aspect of pharmacokinetics. Peripheral edema, hepatitis, and pneumonia would not directly impact excretion.

Format: Multiple Selection Chapter: 13 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 213, Box 13.3, Managing Pinworm Infections

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26. The nurse is presenting at a health promotion event at the local elementary school. What suggestion(s) should the nurse give the attendees to prevent the spread of pinworm infection? Select all that apply. A) Tell the children not to share combs and brushes. B) Tell the children not to drink out of other people’s beverage containers. C) Keep your children’s nails cut short. D) Whenever possible, shower your child each morning during an outbreak. E) Make sure to teach and model good handwashing practices.

Ans: C, D, E

Feedback: Some suggested hygiene measures that might help to control the infection include the following: keep the child’s nails cut short and hands well-scrubbed, because reinfection results from the worm’s eggs being carried back to the mouth after becoming lodged under the fingernails when the child scratches the pruritic perianal area; give the child a shower in the morning to wash away any ova deposited in the anal area during the night. Hand hygiene is vital, especially after using the toilet. There is no particular risk with sharing beverages, combs, or brushes.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 4, 5 Page and Header: 204, Table 13.1 Helminthic Infections 27. An adult client who is homeless and has a history of poor adherence to prescribed medical treatment has been diagnosed with a helminthic infection. What drug would best meet this client’s medical needs and psychosocial circumstances? A) pyrantel B) mebendazole

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C) albendazole D) metronidazole

Ans: A

Feedback: Because it is administered in single dose, pyrantel may be preferred for clients who could have trouble remembering to take medication or following drug regimens. Mebendazole and albendazole require multiple doses. Metronidazole is not used for the treatment of helminthic infections.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 204, Table 13.1 Helminthic Infections 28. Several children from a day care have developed pinworms, and the nurse has been brought in to consult. The nurse should tell parents to watch for what sign of possible infection? A) hard stools with visible worms B) perianal itching C) anorexia and upset stomach D) blood-streaked diarrhea

Ans: B

Feedback: Pinworms manifestation includes perianal itching. Anorexia, dyspepsia, bloody diarrhea, and hard stools are atypical.

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Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4, 5 Page and Header: 204, Table 13.1 Helminthic Infections 29. A client is prescribed pyrantel rather than mebendazole to treat pinworms and roundworms. The nurse should describe which benefit of this medication to the client? A) “Pyrantel needs only be taken once.” B) “Mebendazole has many serious adverse effects.” C) “Pyrantel is excreted in the feces.” D) “Pyrantel is safer for children younger than 2 years.”

Ans: A

Feedback: Pyrantel’s big advantage is that it needs only be taken one time so it is a better choice for those who may not remember to take repeated doses. Mebendazole has very few side effects because very little of the medication is absorbed systemically so that is not a reason to prescribe pyrantel. Pyrantel is mostly excreted in the feces but some is also found in urine, while mebendazole is only excreted in the feces so this does not benefit prescribing pyrantel. Pyrantel has not been established as safe for use in children under 2 years old.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 5

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Page and Header: 204, Intestine-Invading Worm Infections 30. A client’s signs, symptoms, and recent travel history suggest a helminthic infection. What should the nurse do in order to most accurately determine what type of helminth is infecting the client? A) Collect a stool sample for culture and sensitivity. B) Collect a stool sample for ova and parasite. C) Collect blood cultures. D) Review the results of the client’s liver function studies.

Ans: B

Feedback: The only test to specifically determine what helminth is involved is a stool culture for ova and parasite. A simple stool culture would not be likely to identify the helminth. Blood cultures and liver function studies would not identify the specific helminth.

Format: Multiple Selection Chapter: 13 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 1 Page and Header: 206, Cestodes 31. What assessment finding(s) should raise the nurse’s level of suspicion that the client may be infected with cestodes? Select all that apply. A) abdominal discomfort and distention B) weight loss without dieting C) shortness of breath on exertion D) peripheral edema E) decreased level of consciousness

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Ans: A, B

Feedback: Cestodes enter the body as larvae that are found in undercooked meat or fish; they sometimes form worms that are several yards long, people with a tapeworm may experience some abdominal discomfort and distention, as well as weight loss, because the worm eats ingested nutrients. Edema, shortness of breath, and decreased LOC are not associated with cestode infections.

Format: Multiple Selection Chapter: 13 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 213, Box 13.3, Managing Pinworm Infections 32. What consideration should the nurse provide when determining the impact a pinworm infestation has on a family with a school-age child? Select all that apply. A) fear B) long-term affects on child’s learning C) negative emotional consequences D) need for coordinated, effective treatment interventions E) re-enforcement of hygiene practices

Ans: A, C, D

Feedback: Infestation with worms can be a frightening and traumatic experience for most people. Seeing the worm can be an especially difficult experience. It is important to reassure clients and families that these types of infections do not necessarily reflect negatively on their hygiene or lifestyle. While hygiene practices are important, poor practice is not generally the cause of the infestation but rather reinfestation. It takes a

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coordinated effort among medical personnel, families, and clients to control a pinworm infestation. The infestation itself will not directly affect the child’s cognitive abilities.

Format: Multiple Selection Chapter: 13 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 210, Box 13.2, Anthelmintic Agents 33. What assessment is priority for a 70-year-old client who is prescribed an anthelmintic agent? Select all that apply. A) daily food intake B) mental acuity C) fluid intake D) visual acuity E) urinary output

Ans: A, C, E

Feedback: Older clients may be more susceptible to the CNS and GI effects of some of these drugs requiring careful monitoring of hydration and nutritional status. This drug classification is not associated with either mental or visual adverse effects.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 5 Page and Header: 206, Tissue-Invading Worm Infections; 204, Box 13.1 34. Which vacation-related activity is a risk for the development of schistosomiasis when visiting a rural site in Africa or Asia? A) eating raw carrots at the local vegetable market B) swimming in the near-by lake C) eating a local dish containing raw fish D) receive several insect bites while hiking

Ans: B

Feedback: Schistosomiasis is a platyhelminthic infection by a fluke that is carried by a snail. This disease is a common problem in parts of Africa, Asia, and certain South American and Caribbean countries. People become infected when they come in contact with the infested water. Worldwide, Ascaris infection is the most prevalent helminthic infection. It may occur wherever sanitation is poor. Eggs from the soil are ingested with vegetables or other improperly washed foods. Cestodes enter the body as larvae found in undercooked meat or fish. Filariasis refers to infection of the blood and tissues of healthy individuals by worm embryos, which enter the body via insect bites.

Test Generator Questions, Chapter 14, Antineoplastic Agents Format: Multiple Choice Chapter: 14 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 217, Cancer 1. A client has developed cancer. During the pathogenesis of the disease, the cancerous cells have exhibited a loss of cellular differentiation and organization, leading to functional changes. What has this client experienced?

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A) anaplasia B) angiogenesis C) autonomy D) metastasis

Ans: A

Feedback: Cancerous cells exhibit anaplasia, which is a loss of cellular differentiation and organization that leads to a loss of their ability to function normally. Angiogenesis refers to the abnormal cells releasing enzymes that generate blood vessels in the area to supply both oxygen and nutrients to the cells. Cancerous cells exhibit autonomy, which is the ability to grow without the usual homeostatic restrictions that regulate cell growth and control. Metastasis is the process of the cancerous cells traveling from the place of origin to develop new tumors.

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 235, Mitotic Inhibitors; 220, Box 14.11 2. A client with Hodgkin’s disease has been prescribed vincristine. What nursing consideration should the nurse prioritize when administering this drug? A) The nurse should encourage the client to eat six small meals a day. B) The nurse should avoid any skin, eye, or mucous membrane contact with the drug. C) The nurse should avoid using a distal vein. D) The nurse should check for extravasation when the infusion is over.

Ans: B

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Feedback: Special care needs to be taken when administering mitotic inhibitors. The nurse should avoid any skin, eye, or mucous membrane contact with the drug. This type of contact can cause serious reactions and toxicity for the nurse. The nurse should check for extravasation frequently during the infusion and not wait until the infusion is completed; a distal vein should be used; nausea and vomiting are commonly experienced adverse effects of these drugs, and small meals may help the client to maintain adequate nutrition, but this is not the important concern when administering the drug.

Format: Multiple Choice Chapter: 14 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 221, Alkylating Agents; 224, Box 14.4 3. A client with leukemia has been prescribed rasburicase to be administered before chemotherapy. Which assessment should the nurse complete after administration of this medication? A) blood glucose levels B) serum potassium levels C) serum calcium levels D) uric acid levels

Ans: D

Feedback: Rasburicase is approved for the management of plasma uric acid levels in clients with leukemia, lymphoma, and solid malignancies who are receiving antineoplastic therapy associated with tumor lysis and elevated serum uric acid levels. Uric acid levels should be analyzed within 4 hours of each dose of rasburicase. Blood

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glucose, potassium, and calcium levels should not be affected by administration of the drug.

Format: Multiple Choice Chapter: 14 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 231, Antineoplastic Antibiotics; 232, Table 14.3 4. The nurse is caring for a client whose current chemotherapy regimen includes mitomycin. What is the client’s most likely diagnosis? A) neuroblastoma B) metastatic lung cancer C) non-Hodgkin lymphoma D) adenocarcinoma of the pancreas

Ans: D

Feedback: Mitomycin is used before the treatment of disseminated adenocarcinoma of the stomach and pancreas. It is not indicated in the treatment of non-Hodgkin lymphoma, lung cancer, or neuroblastoma.

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Page and Header: 221, Alkylating Agents; 222, Table 14.1 5. The nurse is caring for a client receiving cyclophosphamide. What is the priority nursing action for this client? A) Monitor urinalysis results. B) Provide small, frequent meals. C) Administer an antiemetic when needed. D) Provide vigilant oral care.

Ans: A

Feedback: The priority nursing action would be to monitor the client’s urinalysis results because hemorrhagic cystitis is a potentially fatal adverse effect of cyclophosphamide. Providing small, frequent meals; oral care; and administering an antiemetic are necessary to maintain nutrition when GI effects are severe, but assessments come before interventions, and these interventions are of lower priority than monitoring for hemorrhagic cystitis.

Format: Multiple Selection Chapter: 14 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 225, Nursing Considerations for Patients Receiving Alkylating Agents; 224, Box 14.5 6. A client diagnosed with breast cancer will have radiation therapy and then begin chemotherapy. Drug therapy will consist of a combination of doxorubicin, cyclophosphamide, and paclitaxel. What should the nurse include in the client’s teaching plan concerning the drug therapy? Select all that apply. A) Stay on a low-fat diet during the course of the drug therapy. B) Take special care when shaving or when brushing their teeth.

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C) Avoid large crowds and public places whenever possible D) Stay in bed 2 days after each administration. E) Avoid the use of antiemetics unless absolutely necessary.

Ans: B, C

Feedback: Special care should be taken when shaving or when brushing their teeth because the client may bruise more easily than normal and gums may bleed. A cancer client should not be on a diet during chemotherapy unless prescribed. Care should be taken to avoid crowds and public places where risk of infection is greater. Cancer clients should remain as active as tolerated, but they should be careful not to overextend themselves physically to promote optimal health. Antiemetics should be used as prescribed, as needed, to prevent and treat nausea. Format: Multiple Choice Chapter: 14 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 227, Antimetabolites 7. The nurse is caring for a client who has been diagnosed with leukemia. What aspect of this client’s health status should the nurse prioritize when confirming the appropriateness and dosing of antimetabolites? A) The client currently has bone marrow suppression. B) The client has a long-standing diagnosis of type 2 diabetes mellitus. C) The client’s blood pressure is usually in the range of 140/90 mm Hg. D) The client has had seizure activity in recent months.

Ans: A

Feedback: Bone marrow is often the index for dosing and redosing levels. Caution should be used and strict monitoring done for clients with suppressed bone marrow who

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are receiving an antimetabolite. Diabetes mellitus, hypertension, and seizure activity have not been identified as interfering with this drug therapy.

Format: Multiple Choice Chapter: 14 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Moderate Integrated Process: Caring Objective: 2, 5 Page and Header: 230, Nursing Considerations for Patients Receiving Antimetabolites 8. The nurse is caring for a client who is receiving a combination of antimetabolite agents. The client has been told that alopecia is likely to occur, and the client is tearful and distraught about this. What is the nurse’s best response? A) Reassure the client that other people who are treated with cancer also experience this. B) Encourage the client to view the hair loss as something that indicates cancer is being eradicated. C) Reassure the client that the hair loss will be temporary rather than permanent. D) Validate the client’s sense of impending loss and offer guidance for getting a wig.

Ans: D

Feedback: The nurse should empathically validate the client’s sense of loss. As well, offering to assist with a practical solution is useful. The facts that the hair loss is temporary and happens to other people are unlikely to provide any real consolation. Similarly, telling the client to see it as a positive is likely to be interpreted as simplistic.

Format: Multiple Selection Chapter: 14 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 230, Nursing Considerations for Patients Receiving Antimetabolites 9. A client diagnosed with a malignancy is receiving an antimetabolite as part of medication therapy. What should the nurse teach this client about the use of antimetabolite medication? Select all that apply. A) Report all other drugs and alternative therapies currently being taken. B) Use safety measures due to possible dizziness, headache, and drowsiness. C) Cover their head during temperature extremes. D) Plan for an appropriate exercise regimen. E) Avoid the consumption of high-tyramine foods.

Ans: A, B, C

Feedback: Provide the following client teaching: follow the appropriate dosage regimen, including dates to return for further doses. Patients need to be reminded to report all other drugs and alternative therapies that they might be using; maintain nutrition if GI effects are severe; cover the head at extremes of temperature if alopecia is anticipated; plan for appropriate rest periods because fatigue and weakness are common adverse effects of the drugs; avoid infection including avoiding crowded places, sick people, and working in soil; and use safety measures such as not driving or using dangerous equipment due to possible dizziness, headache, and drowsiness. The nurse would not tell the client to plan for appropriate exercise regimens because clients are more likely to need encouragement to rest; there is no reason to avoid tyramines.

Format: Multiple Choice Chapter: 14 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy

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Integrated Process: Nursing Process Objective: 1 Page and Header: 217, Cancer 10. A client diagnosed with cancer is experiencing pain and the early signs of organ dysfunction. How should the nurse explain these signs and symptoms originate? A) overgrowth of tumor cells B) enzymes that generate blood vessels C) tumor cells invading healthy tissue D) the body’s own misguided immune response

Ans: C

Feedback: As cancer cells grow, they invade and damage healthy host tissues, and this is what causes signs and symptoms of cancer. When cancer metastasizes, the tumor cells invade new tissue, and other signs and symptoms occur. Cancer cells do overgrow, and the abnormal cells do release enzymes that generate blood vessels, but this is not what causes the signs and symptoms of cancer. The effects of neoplasms are not caused by overgrowth of tumor cells, enzymes that generate blood vessels, or the body’s own immune response.

Format: Multiple Choice Chapter: 14 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 217, Cancer 11. The nurse is caring for a client who has been newly diagnosed with a primary brain tumor. The client asks the nurse where the tumor came from. What is the nurse’s best response?

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A) “Your tumor originated from somewhere outside the central nervous system from a cell just like other cells.” B) “Your tumor most likely originated with a mutation in the pituitary gland that released pathologic hormones.” C) “Your tumor originated from a single cell that is genetically different from nearby cells.” D) “Your tumor originated from changes in the structure of nerve tissue somewhere in your body.”

Ans: C

Feedback: All cancers start with a single cell that is genetically different from the other cells in the surrounding tissue. Determining the site of the first cell to genetically mutate in this client would require more information so it is impossible to say if the originating cell was in the CNS, the pituitary gland, or peripheral nerve tissue.

Format: Multiple Selection Chapter: 14 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 225, Nursing Considerations for Patients Receiving Alkylating Agents 12. A client is experiencing intense nausea while being treated with chemotherapeutics. What actions should the nurse perform? Select all that apply. A) Provide the client with a low-residue diet. B) Ensure that the client has had a dietician consult. C) Administer antacids as prescribed, 30 minutes before meals. D) Administer antiemetics as prescribed. E) Provide the client with small, frequent meals. Ans: B, D, E

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Feedback: A dietician should consult in the treatment of a client with nausea secondary to chemotherapy. Small, frequent meals and vigilant use of antiemetics are useful as well. There is no need for a low-residue diet, and antacids do not normally prevent nausea.

Format: Multiple Choice Chapter: 14 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 247, Critical Thinking Scenario: Antineoplastic Therapy and Breast Cancer 13. A client who is taking chemotherapeutic medications has developed stomatitis. What intervention should the nurse include in the client’s plan of care? A) Provide mouth care frequently. B) Provide a minced or pureed diet. C) Encourage the client’s family to bring in mouthwash. D) Administer antifungal mouthwash as prescribed.

Ans: A

Feedback: Stomatitis requires frequent mouth care. Commercial mouthwashes are likely to burn any open lesions, and stomatitis does not have a fungal etiology. Spicy or exceptionally hard foods should be avoided, but there is no need to limit the client’s diet to minced and pureed foods.

Format: Multiple Selection Chapter: 14

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 251, Miscellaneous Antineoplastics 14. The nurse is caring for a client receiving a combination of antineoplastic medications. The client asks the nurse why so many different medications are being used instead of just one medication. The nurse should explain what characteristics of combination therapy? Select all that apply. A) decreases the development of cell resistance B) prolongs the length of treatment C) increases the quantity of each medication used D) decreases the adverse effects of each medication E) targets different phases of the cell cycle

Ans: A, E

Feedback: Malignant cells that remain in a dormant phase for long periods are difficult to destroy. These cells can emerge long after cancer treatment has finished—after weeks, months, or years—to begin their division and growth cycle all over again. For this reason, antineoplastic agents are often given in sequence over periods of time, in the hope that the drugs will affect the cancer cells as they emerge from dormancy or move into a new phase of the cell cycle. A combination of antineoplastic agents targeting different phases of the cell cycle is frequently most effective in treating many cancers. Combinations of drugs do not increase the length of treatment, increase the quantity of medication used, or decrease the adverse effects of the medications used.

Format: Multiple Choice Chapter: 14 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze

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Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 238, Hormones and Hormone Modulators; 239, Table 14.5 15. The nurse is caring for a client whose current antineoplastic regimen includes bicalutamide. The nurse should anticipate what additional aspect of this client’s cancer treatment? A) thyroidectomy B) hemicolectomy C) total mastectomy D) prostatectomy

Ans: D

Feedback: Bicalutamide is administered in combination with a luteinizing hormone for the treatment of advanced prostate cancer. This medication would not be effective for treating bowel, thyroid, or breast cancer because it is a hormone modulator and works only on androgen receptor sites.

Format: Multiple Selection Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 227, Antimetabolites 16. The nurse is providing care for an older adult client who has stomatitis secondary to the administration of methotrexate. The nurse should assess for indication(s) of what nursing diagnoses? Select all that apply. A) altered body image perception related to alopecia, skin effects, impaired fertility B) infection risk due to bone marrow suppression

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C) malnutrition risk related to GI effects D) impaired comfort related to GI, CNS, or skin effects E) autonomic dysreflexia

Ans: A, B, C, D

Feedback: Because of the common adverse effects of severe bone marrow suppression, the client should be assessed for impaired skin integrity related to rash, risk for infection, and risk for bleeding related to severe bone marrow suppression. Because the client has stomatitis, there is a risk for imbalanced nutrition less than body requirements because eating is uncomfortable and not feeling well will also reduce appetite. Autonomic dysreflexia is limited to clients who have spinal cord injuries.

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 231, Antineoplastic Antibiotics 17. The nurse is preparing to administer doxorubicin for a client who has been diagnosed with neuroblastoma. What action should the nurse perform? A) Assess client for indications of cardiotoxicity. B) Assess the integrity of the client’s mucous membranes. C) Assess the integrity of the client’s deltoid sites. D) Perform hand hygiene before administration to protect against cytotoxic effects.

Ans: A

Feedback: Doxorubicin has been known to cause cardiotoxicity in addition to nonharmful red coloration of urine and sweat. These precautions include protective

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equipment. Hand hygiene should be performed before administering any medication, but this measure does not protect the nurse from cytotoxic effects. The medication is given intravenously, so the status of the client’s deltoids is not relevant. The condition of the client’s mucous membranes does not directly affect the IV administration of doxorubicin.

Format: Multiple Choice Chapter: 14 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 221, Alkylating Agents; 221, Box 14.3 18. The client has just been started on an alkylating agent to treat testicular cancer. What assessment finding would suggest that the client is experiencing a common adverse effect of this medication? A) The client’s most recent laboratory results indicate pancytopenia. B) The client describes “bone pain” in the lumbar and thoracic spine. C) The client is oriented to person but not to place and time. D) The client describes the mood as “bleak” and “dark.”

Ans: A

Feedback: Hematological effects include bone marrow suppression, with leukopenia, thrombocytopenia, anemia, and pancytopenia, secondary to the effects of the drugs on the rapidly multiplying cells of the bone marrow. Bone pain, depression, and disorientation are not common adverse effects of alkylating agents.

Format: Multiple Choice Chapter: 14 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 225, Nursing Considerations for Patients Receiving Alkylating Agents; 221, Box 14.3 19. The client is taking ifosfamide as a component of cancer treatment, and the client’s oncologist has just added mesna to the client’s medication regimen. How should the nurse best assess for the therapeutic effect of mesna? A) assessing the client’s pain levels on an hourly basis B) monitoring the client’s bowel movements for frequency and character C) assessing the client for nausea and vomiting D) monitoring the client’s urine output for signs of hematuria

Ans: D

Feedback: Mesna combines with a urotoxic metabolite of ifosfamide to reduce the damaging effects of ifosfamide. It addresses the risk of hemorrhagic cystitis, so the absence of hematuria would suggest that it is having the intended effect. Mesna is not given to address diarrhea, pain, or nausea.

Format: Multiple Selection Chapter: 14 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4, 5 Page and Header: 221, Alkylating Agents 20. Chlorambucil has been ordered for a client diagnosed with Hodgkin’s disease. The nurse should assess what domains when monitoring for adverse effects? Select all that apply.

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A) tremors B) muscle twitching C) confusion D) gynecomastia E) visual disturbances

Ans: A, B, C

Feedback: Chlorambucil is a palliative treatment for chronic lymphocytic leukemia, malignant lymphomas, and Hodgkin’s disease. Adverse effects include tremors, muscle twitching, and confusion, but not gynecomastia or vision changes.

Format: Multiple Choice Chapter: 14 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 231, Antineoplastic Antibiotics; 221, Box 14.3 21. A client with acute myeloblastic leukemia is taking doxorubicin, and the oncologist has added dexrazoxane to the drug regimen. What system should the nurse assess when monitoring for therapeutic effects of dexrazoxane? A) cardiac B) respiratory C) gastrointestinal D) genitourinary

Ans: A

Feedback: Dexrazoxane is a powerful chelating agent that is a cardioprotective drug that interferes with the cardiotoxic effects of doxorubicin. Cardiac assessment would

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monitor its therapeutic action. Respiratory, gastrointestinal, and genitourinary assessments would not monitor the cardiotoxic effects of doxorubicin.

Format: Multiple Choice Chapter: 14 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 238, Hormones and Hormone Modulators; 241 Prototype Summary: Tamoxifen 22. A 39-year-old client has begun taking tamoxifen to reduce the risk of contralateral breast cancer. The client is now reporting hot flashes and dysmenorrhea. What is the nurse’s best action? A) Tell the client to stop taking the drug immediately and contact the prescriber. B) Encourage the client to ask their provider about the possible use of dexrazoxane to relieve these effects. C) Encourage the client to speak with their care provider about hormone therapy. D) Inform the client that these are likely adverse effects of drug therapy.

Ans: D

Feedback: Adverse effects of tamoxifen include hot flashes, rash, nausea, vomiting, vaginal bleeding, menstrual irregularities, edema, pain, cerebrovascular accident, and pulmonary emboli. These effects do not likely warrant discontinuing the drug. Hormone therapy would not be prescribed for the sole purpose of addressing these adverse effects. Dexrazoxane confers cardioprotective effects; it does not address adverse effects of tamoxifen therapy.

Format: Multiple Choice

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Chapter: 14 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 3, 4, 5 Page and Header: 227, Antimetabolites 23. A female client is prescribed methotrexate for meningeal leukemia. What health education should the nurse prioritize? A) Use reliable forms of barrier contraception. B) Discontinue oral contraceptives. C) Avoid grapefruit juice. D) Abstain from alcohol until 7 days after treatment.

Ans: A

Feedback: Antimetabolites are contraindicated for use during pregnancy and lactation because of the potential for severe adverse effects on the fetus and neonate. There is no need to discontinue oral contraceptives, but barrier methods should also be used. There is no need to avoid grapefruit juice, and prolonged abstinence from alcohol is not required.

Format: Multiple Choice Chapter: 14 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 221, Alkylating Agents 24. What is the nurse’s priority intervention to reduce the risk of renal damage caused by cyclophosphamide?

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A) Encourage the client to drink cranberry juice. B) Promote adequate rest and sleep. C) Encourage fluids to maintain hydration. D) Instruct the client to wear only cotton underwear.

Ans: C

Feedback: To prevent renal damage, the nurse should ensure that the client is well hydrated. Drinking cranberry juice or milk helps to hydrate the client, but what the client drinks is less important than that they drink adequate amounts of fluid. Wearing cotton underwear is not an intervention the nurse would teach the client.

Format: Multiple Choice Chapter: 14 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 237, Box 14.9 25. The nurse is administering a client’s chemotherapeutic drug through a peripheral IV site, and the nurse observes that extravasation has occurred. What is the nurse’s best action? A) Administer a bolus of 0.9% NaCl or 0.45% NaCl to dilute the drug. B) Stop the infusion and inform the health care provider immediately. C) Stop the infusion, document the event, and monitor the IV site closely. D) Establish another IV site so that the antidote can be administered.

Ans: B

Feedback: Extravasation should prompt the nurse to stop the infusion and collaborate promptly with the care provider. A bolus would cause more harm than benefit, by

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distributing the drug in compromised tissue. Monitoring is not a sufficient response, and another IV site may or may not be needed.

Format: Multiple Choice Chapter: 14 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 235, Mitotic Inhibitors 26. A nurse prepares a plan of care for a client diagnosed with rhabdomyosarcoma. The client has been admitted for chemotherapy with vincristine. The nurse determines which nursing conclusion is appropriate? A) altered body image due to severe fluid retention B) risk for bleeding due to possible hemorrhagic cystitis C) risk for injury related to muscle wasting and weight loss D) risk of infection related to possible nosocomial infection

Ans: C

Feedback: Adverse effects of vincristine include ataxia, cranial nerve manifestations, neuritic pain, muscle wasting, constipation, leukopenia, weight loss, loss of hair, and death. As a result, the risk for injury due to weakness and falls is a significant concept. Risk for bleeding and severe fluid retention is unlikely with this drug. The risk of infection is related to bone marrow suppression, not a possible nosocomial infection. The client is more at risk for a nosocomial infection because of the bone marrow suppression.

Format: Multiple Selection Chapter: 14 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 226, Dealing with Bone Marrow Suppression; 224, Box 14.5 27. What effect will the client experience related to the affect of bone marrow suppression on their blood cells? Select all that apply. A) arrhythmia B) fatigue C) bruising D) infection E) dementia

Ans: A, B, C, D

Feedback: Bone marrow suppression is a frequently encountered adverse effect of antineoplastic chemotherapy. The cells in the bone marrow are rapidly turning over cells, constantly stimulated to produce blood components, and so they are more likely to be affected by drugs that kill cells. The client may experience a low red blood cell (RBC) count (anemia-induced fatigue and cardiac arrhythmias), low platelet counts resulting in easy bruising, and infections resulting from low white blood cell (WBC) counts. Bone marrow suppression has no direct affect on cognitive function.

Format: Multiple Choice Chapter: 14 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 225, Nursing Considerations for Clients Receiving Alkylating Agents; 226, Box 14.6

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28. What information should the nurse share with a client prescribed an antineoplastic drug regarding the management of symptoms triggered by its affect on the chemoreceptor trigger zone (CTZ)? A) A combination of drugs may be prescribed to manage nausea and vomiting. B) Sufficient hydration will minimize the risk of dizziness. C) An antihistamine will be prescribed to manage excess secretions. D) A corticosteroid will be needed to manage related inflammation.

Ans: A

Feedback: Antineoplastic drugs can directly stimulate the chemoreceptor trigger zone (CTZ) in the medulla to induce nausea and vomiting. A variety of antiemetic agents have been used in the course of antineoplastic therapy. Sometimes a combination of drugs is most helpful. It should also be knowledge that an accepting environment, plenty of comfort measures (e.g., environmental control, mouth care, ice chips), and support for the client can help to decrease the discomfort associated with the emetic effects of these drugs. The CTZ is not related to dehydration, secretion production, or inflammation.

Format: Fill-in-the-Blank Chapter: 14 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 235, Mitotic Inhibitors; 235, Table 14.4 29. A client with advanced ovarian cancer has been prescribed paclitaxel 160 mg/m2 IV administered over 3 hours. The client’s body surface area is 1.6 m2, and the drug is to be diluted in 250 mL of D5NS. At what rate in milliliter/hour should the drug be administered? Round your answer to the nearest tenth.

Ans: 83.3 mL/h

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Feedback: The nurse does not need to know the final dose (256 mg) in order to determine the rate of administration, because the final volume to be infused (250 mL) and the desired rate are known. The rate in milliliter/hour is simply determined by dividing the total volume (250 mL) by the time in hours (3). This yields 83.333 mL/h, or 83.3 mL/h to one decimal place.

Format: Multiple Choice Chapter: 14 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 218, Antineoplastic Drugs; 220, Box 14.1 30. The nurse transfers from the adult oncology unit to the pediatric oncology unit. What will the nurse need to add to the client’s plan of care that was not a part of the adult client’s care plan? A) social, emotional, and intellectual stimulation B) concerns related to combination drug therapy C) double-checking dosage calculations and appropriateness of drug dosage D) monitor for hydration and nutritional status

Ans: A

Feedback: Children need to play and learn so meeting the child’s social, emotional, and intellectual needs is a part of the care plan that was not as significant with adults. Administration of combination drugs, double-checking dosage calculations and appropriateness of drug dosage, and monitoring for hydration and nutritional status are all components of adult care as well as pediatric care.

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Format: Multiple Selection Chapter: 14 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 3 Page and Header: 218, Antineoplastic Drugs; 220, Box 14.1 31. The nurse is conducting a class for oncologic nurses. What characteristics of chemotherapy for older adults should the nurse identify? Select all that apply. A) Older adults may be more susceptible to the central nervous system (CNS) and GI effects of these drugs. B) Older clients are at risk for dehydration and diminished nutritional status. C) Safety precautions should be instituted once administration begins. D) Dosage adjustments are made on the basis of the age of the older adult. E) Older adults are already somewhat immunosuppressed, so further suppression is a concern.

Ans: A, B, E

Feedback: Older adults may be more susceptible to the CNS and GI effects of some of these drugs. Older clients should be monitored for hydration and nutritional status regularly. Safety precautions should be instituted if CNS effects occur but are not needed for every drug as soon as it is initiated. Dosage is adjusted based on hepatic and renal function, not the client’s age. Protecting these clients from exposure to infection and injury is a very important aspect of their nursing care because older clients are naturally somewhat immunosuppressed because of age.

Format: Multiple Choice Chapter: 14 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 237, Box 14.9, Preventing and Treating Extravasation 32. What is the best way to deal with the risk of extravasation when administrating an antineoplastic medication? A) Utilize an infusion pump to deliver the medication. B) Apply a solution of hyaluronidase directly to the traumatized site. C) Follow the administration with a D5W flush. D) Use an existing line unless it is clearly open and running well.

Ans: D

Feedback: Interventions that can help to prevent extravasation include the following: use a distal vein, and avoid small veins on the wrist or digits; never use an existing line unless it is clearly open and running well; start the infusion with plain 5% dextrose in water (D5W), and monitor for any sign of extravasation; check the site frequently, and ask the client to report any discomfort in the area; and, if at all possible, do not use an infusion pump to administer one of these drugs because it will continue to deliver the drug under pressure and can cause severe extravasation. If extravasation occurs, there are specific antidotes to use with some antineoplastic drugs. Hyaluronidase and sodium thiosulfate are two examples of antidotes. The antidote is usually administered through the IV line to allow it to infiltrate the same tissue.

Test Generator Questions, Chapter 15, Introduction to the Immune Response and Inflammation Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy

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Integrated Process: Nursing Process Objective: 1 Page and Header: 258, Body Defenses 1. A client has entered an environment where there are numerous infectious microorganisms. The body’s first line of defense against these organisms is considered to be what? A) mast cells B) mucous membranes C) skin D) T cells

Ans: C

Feedback: The skin is the first line of barrier defense. It acts as a physical barrier to protect the internal tissues and organs of the body. Mast cells are part of cellular defense. They are found in the respiratory and GI tracts and are fixed basophils that do not circulate. Mucous membranes are a barrier defense that line the areas of the body that are exposed to external influences but do not have the benefit of skin protection. T cells are part of the immune response and provide cell-mediated immunity. Activation of a T cell by a non–self-cell results in responses that destroy foreign cells.

Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 1, 2 Page and Header: 258, Body Defenses 2. The nurse is caring for a number of clients. Which client has lost a barrier defense, increasing the client’s risk for infection? A) a 68-year-old man diagnosed with prostate cancer

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B) a 24-year-old client diagnosed with partial-thickness burns C) a 13-year-old client diagnosed with chickenpox D) a 72-year-old client diagnosed with bacterial pneumonia

Ans: B

Feedback: A burn client loses the protective barrier of the skin and is at risk for infection. In a partial-thickness burn, the glands of the skin secrete chemicals that destroy many pathogens and also the normal flora that live on the skin. A cancer client has decreased cellular defenses. The client with chickenpox and the client with pneumonia both have a diminished immune defense along with the prostate cancer client but still are at less risk for infection than the burn client.

Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 258, Body Defenses 3. The nurse is reviewing the results of the complete blood count of a client who is diagnosed with bacterial meningitis. What value should the nurse expect to see elevated? A) basophil count B) eosinophil count C) hematocrit D) neutrophil count

Ans: D

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Feedback: During an acute infection, the neutrophils are rapidly produced in response to the interleukins released by active white blood cells. They move to the site of insult to attack the foreign substance. Eosinophils are often increased in an allergic response. Basophils would only increase with generalized bone marrow stimulation. The hematocrit level is increased in polycythemia.

Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Difficult Integrated Process: Communication and Documentation Objective: 4 Page and Header: 258, Body Defenses 4. A parent calls the clinic and tells the nurse that the their toddler has a temperature of 102°F (38.9°C). What should the nurse teach the parent about the child’s fever? A) “A fever is the body’s way of fighting an infection and supporting the body’s immune system.” B) “Neutrophils release pyrogen, a fever-causing substance, which helps act as a catalyst for the body’s inflammatory and immune responses.” C) “Leukotrienes activated by arachidonic acid attract neutrophils to start the process of fighting inflammation.” D) “Inflammation causes the activation of a chemical called Hageman factor that initiates a process to bring more blood to the injured area and allows white blood cells to escape into the tissues.”

Ans: A

Feedback: The best response by the nurse would be that a fever actually increases the efficiency of the immune and inflammatory responses, helping the body to fight the infection. While the other three statements are correct, they are more technical and include terminology that a new mother may not understand or even care about. If the

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appropriate response does not suffice and the mother still has questions, the nurse would then go into more detail and use the rationale from the other options to explain in greater detail.

Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 4 Page and Header: 258, Body Defenses 5. A client has a sports injury and the affected region is inflamed. The nurse should understand that the inflammatory response caused by the injury will occur in what sequence? A) heat, pain, redness, swelling B) swelling, pain, redness, heat C) redness, swelling, heat, pain D) pain, redness, swelling, heat

Ans: C

Feedback: The inflammatory response will begin with redness in the direct line of the infected wound. Next, swelling will occur because of the fluid that leaks into the tissue as a result of the change in capillary permeability. The heat can be detected due to the increased blood flow to the area. Pain will be felt due to the activation of fibers by histamine and the kinin system as well as stretching of the tissue caused by the edema.

Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation

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Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 258, Body Defenses 6. The nurse is caring for a client who is immunocompromised and is explaining the function of cytotoxic T cells. What should the nurse explain to this client? A) “Cytotoxic T cells are programmed to identify specific proteins or antigens that are foreign to your body.” B) “These T cells can either destroy a foreign cell or mark it for aggressive destruction by another cell.” C) “These cells respond to chemical indicators of immune activity and stimulate other lymphocytes to be more aggressive and responsive.” D) “These are cells that respond to rising levels of chemicals associated with an immune response in order to suppress or slow the reaction.”

Ans: B

Feedback: Effector or cytotoxic T cells either destroy a foreign cell or make it available for aggressive destruction. Cells that identify specific proteins or antigens are B cells. Cells that respond to chemical indicators to stimulate other cells are helper T cells. Cells that suppress or slow the reaction are suppressor T cells.

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7. A client has a significant laceration on the left arm. Since the injury, the client has had muscle and joint aches, a low-grade fever, and sleepiness. The nurse should attribute this to what component of the inflammatory response? A) bacterial toxins B) interferon activity C) leukotriene activity D) phagocytosis

Ans: C

Feedback: The leukotrienes (autocoids activated through the kinin system) affect the brain to induce slow-wave sleep, believed to be an important energy conservation measure for fighting the invader. They also cause myalgia and arthralgia (muscle and joint pain)—common signs and symptoms of various inflammatory diseases, which also cause reduced activity and save energy. Interferons are released in response to viral infection. Phagocytosis destroys engulfed foreign material in the body. Bacterial toxins cause local reactions unless the infection is intense and the bacteria enter the bloodstream.

Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 258, Body Defenses 8. The nurse is caring for an immunocompromised client and is reviewing the role of factor XII (Hageman factor). What normally occurs when Hageman factor activates kallikrein? A) Arachidonic acid is produced. B) Prostaglandins are rapidly synthesized and released.

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C) Leukotrienes are released into general circulation. D) Kininogen is converted to bradykinin.

Ans: D

Feedback: Hageman factor activates kallikrein, a substance found in the local tissues, which causes the precursor substance kininogen to be converted to bradykinin and other kinins. Bradykinin causes the release of arachidonic acid from the cell membrane. Arachidonic acid causes the release of other substances called autocoids, including prostaglandins, leukotrienes, and thromboxanes.

Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 258, Body Defenses 9. A client who has received a heart transplant has been given a prescription for medications that block T-cell activity. What is the rationale behind this order? A) to manufacture antibodies to the foreign proteins in the new heart B) to stimulate wound healing C) to temporarily suppress bone marrow function D) to prevent an inflammatory reaction against the transplanted heart

Ans: D

Feedback: Effector or cytotoxic T cells are aggressive against non–self-cells, releasing cytokines that can either directly destroy a foreign cell or mark it for aggressive destruction. If the transplanted organ is attacked by cytokines, it will be destroyed, referred to as “organ rejection.” As a result, inhibition of these killer T cells is essential

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to continued organ function in the transplanted organ. Blocking T cells would not manufacture antibodies and stimulate wound healing. These medications do not suppress overall bone marrow function.

Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 267, Summary 10. The nurse anticipates what nonspecific response to a client’s abrasion injury? A) decreased serum pH B) increased protein catabolism C) inhibition of cell growth and conservation of energy D) heat and swelling

Ans: D

Feedback: The inflammatory response is the local reaction of the body to invasion or injury. Any insult to the body that injures cells or tissues sets of a series of events and chemical reactions known as the inflammatory response, which includes heat and swelling. Protein catabolism is the breakdown of protein into particles small enough to be carried into the cell and is an incorrect choice. Cellular injury does not inhibit cell growth or lower pH.

Format: Multiple Selection Chapter: 15 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Analyze

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 258, Body Defenses 11. The nurse is planning care for a client with extensive burns suffered in a workplace accident. The nurse has identified a priority nursing diagnosis of risk for infection related to loss of body defenses. What barrier defenses may be compromised in this client? Select all that apply. A) skin B) mucous membranes C) gastric acid D) leukocytes E) T cells Ans: A, B, C

Feedback: The skin is the first line of barrier defense, creating a physical barrier to prevent pathogens from entering the internal tissues. Mucous membranes are another barrier defense protecting the area without skin protection (e.g., the respiratory tract, gastrointestinal tract, genitourinary tract). Gastric acids destroy many pathogens that are ingested or swallowed, preventing them from entering the bloodstream or internal organs. Leukocytes and T cells are cellular defenses and not barrier defenses.

Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 258, Body Defenses 12. A client is fighting an active infection, and antigen–antibody complexes are being created. How will these new complexes enhance the immune response?

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A) They create new receptor sites that can activate complement proteins. B) They directly block viral passage through body cell membranes. C) They activate cytotoxic T cells, which can directly attack pathogens. D) They stimulate the thymus to release B cells in larger quantities.

Ans: A

Feedback: When the antigens and antibodies react, they form an antigen–antibody complex. This new structure reveals a new receptor site on the antibody that activates a series of plasma proteins in the body called “complement proteins.” This process is unrelated to the role of the thymus, cytotoxic T cells, or cell membrane structure.

Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 5 Page and Header: 258, Body Defenses 13. The immune system of a client with an infection has created complement proteins. What immunologic response is most likely to result from complement proteins? A) synthesis of IgG B) chemotaxis C) inflammation D) synthesis and release of IgA

Ans: B

Feedback: Activated complement stimulates chemotaxis (movement of monocytes, neutrophils, basophils, and eosinophils toward the antigen) and the release of hydrolytic enzymes; actions that result in the destruction or inactivation of the invading antigen.

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Complement proteins do not directly cause the synthesis of immunoglobulins, and they do not participate in inflammation.

Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 258, Body Defenses 14. The nurse is explaining to a client how an antigen previously encountered elicits a much faster immune response because the body’s immune cells “remember” previous encounters with the antigen. The nurse is describing the function of what cells? A) T cells B) lymphocytes C) monocytes D) B cells

Ans: D

Feedback: After being activated, the B cells form memory cells that will produce antibodies for immediate release in the future if the antigen is encountered again. Although lymphocytes, monocytes, and T cells will then join in the battle to destroy the antigen, they do not produce memory cells as the B cells do.

Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Easy

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Integrated Process: Nursing Process Objective: 2 Page and Header: 258, Body Defenses 15. A client’s most recent laboratory work reveals neutropenia. This client will have a diminished capacity for what process? A) phagocytosis B) producing memory cells C) marking cells for destruction D) complement production

Ans: A

Feedback: Neutrophils engulf and digest foreign material through the process of phagocytosis. B cells produce memory cells. Cytotoxic T cells mark cells for destruction. Neutrophils do not produce complement.

Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 265, Pathophysiology Involving the Immune System 16. A client has been diagnosed with an autoimmune disease that causes numerous distressing symptoms. What pathophysiologic process is causing this client’s symptoms? A) The client’s body is producing antibodies against the client’s own self-antigens. B) Viruses have taken over the client’s B cells, causing them to attack the client’s own cells. C) Cytotoxic T cells have begun to phagocytize one another, rather than pathogens. D) B cells are producing antibodies that promote cell malignancy.

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Ans: A

Feedback: Autoimmune disease occurs when the body responds to specific self-antigens to produce antibodies or cell-mediated immune responses against its own cells. This does not occur, however, because viruses have “taken over” healthy cells or because cytotoxic T cells have turned on one another. Malignancy is not normally involved.

Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 258, Body Defenses 17. What client is most likely benefiting from the effects of tumor necrosis factor (TNF) cytokines? A) a client who has viral meningitis B) a client who has ductal carcinoma in situ (DCIS) C) a client who has systemic lupus erythematosus (SLE) D) a client who has human immunodeficiency syndrome (HIV)

Ans: B

Feedback: Tumor necrosis factor (TNF), a cytokine, is a chemical released by macrophages that inhibits tumor growth and can cause tumor regression. It would be more significant in a client with a form of cancer than a client with a viral infection or an autoimmune disease.

Format: Multiple Selection Chapter: 15

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Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 258, Introduction 18. A client’s varied stressors are believed to be having a negative impact on the client’s immune response. What could the nurse classify as a stressor? Select all that apply. A) trauma B) foreign cells C) viruses D) extremes of environmental conditions E) self-cells

Ans: A, B, C, D

Feedback: The term “stressors” can include bacteria, viruses, other foreign pathogens or non–self-cells, trauma, and exposure to extremes of environmental conditions. Selfcells are not considered a stressor on the body.

Format: Multiple Choice Chapter: 15 Client Needs: Health Promotion and Maintenance Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 265, Pathophysiology Involving the Immune System 19. The nurse is caring for a client who has been newly diagnosed with multiple sclerosis (MS). The client asks why MS is called an autoimmune disease. What is the nurse’s best response?

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A) “The body attacks its own cells because it responds to specific self-antigens to produce antibodies.” B) “The body responds to a cell invaded by bacteria with antibody production against similar cells.” C) “Production of autoantibodies is a normal process that goes on all the time, but immunosuppression limits B-cell response.” D) “People with multiple sclerosis have a genetic predisposition to destroy autoantibodies.”

Ans: A

Feedback: Autoimmune disease occurs when the body responds to specific self-antigens to produce antibodies or cell-mediated immune responses against its own cells. The actual cause of autoimmune disease is not known, but theories speculate that (1) it could be a result of response to a cell that was invaded by a virus, leading to antibody production to similar cells; (2) production of autoantibodies is a normal process that goes continuously, but in a state of immunosuppression, the suppressor T cells do not suppress autoantibody production; or (3) a genetic predisposition to develop autoantibodies is present.

Format: Multiple Selection Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 258, Body Defenses 20. The nurse is caring for a client diagnosed with an acute infection that resulted in a prompt immune reaction. What signs or symptoms experienced by the client would the nurse recognize as being mediated by interleukins? Select all that apply. A) fever

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B) joint pain C) muscle pain D) hyperactivity E) insomnia

Ans: A, B, C

Feedback: Interleukins cause many of the symptoms associated with flulike symptoms, all things that help the body to conserve energy including fever, joint pain (arthralgia), muscle pain (myalgia), and slow-wave sleep induction. Hyperactivity and insomnia are not associated with interleukin activity.

Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 258, Body Defenses 21. A client is experiencing an allergy to a penicillin antibiotic. What immunoglobulin (Ig) will most directly relate to this immune response associated with mast cells? A) IgM B) IgG C) IgE D) IgA Ans: C

Feedback: Five different types of immunoglobulins have been identified: IgE is present in small amounts and seems to be related to allergic responses and to the activation of mast cells. The first immunoglobulin released is M (IgM). It contains the antibodies produced at the first exposure to the antigen. IgG, another form of immunoglobulin,

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contains antibodies made by the memory cells that circulate and enter the tissue; most immunoglobulin found in the serum is IgG. IgA is found in tears, saliva, sweat, mucus, and bile. It is secreted by plasma cells in the GI and respiratory tracts and in epithelial cells. These antibodies react with specific pathogens that are encountered in exposed areas of the body.

Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 258, Body Defenses 22. A nurse received the seasonal influenza vaccine 10 weeks ago has now been exposed to that strain of the influenza virus. What immunoglobulin will hasten the nurse’s immune response to this pathogen? A) IgG B) IgA C) IgM D) IgE

Ans: A

Feedback: Five different types of immunoglobulins have been identified: IgA is found in tears, saliva, sweat, mucus, and bile. It is secreted by plasma cells in the GI and respiratory tracts and in epithelial cells. IgE is present in small amounts and seems to be related to allergic responses and to the activation of mast cells. The first immunoglobulin released is M (IgM); it contains the antibodies produced at the first exposure to the antigen. IgG, another form of immunoglobulin, contains antibodies made by the memory cells that circulate and enter the tissue; most of the immunoglobulin found in the serum is IgG, and vaccinations make use of this immunoglobulin’s characteristics. These

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antibodies react with specific pathogens that are encountered in exposed areas of the body.

Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 5 Page and Header: 258, Body Defenses 23. A client reports an exposure to chicken pox as a child, but they do not understand why that now makes them immune to subsequent infections with the same virus. During client teaching, the nurse should describe the actions of what immunoglobulin? A) immunoglobulin A B) immunoglobulin M C) immunoglobulin G D) immunoglobulin E

Ans: C

Feedback: After an active infection, the B memory cells will continue to make a supply of immunoglobulin, IgG, for use on future exposure to the chicken pox virus. The presence of this IgG confers immunity on the client. This is not a direct result of the actions of other immunoglobulins.

Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 2 Page and Header: 258, Body Defenses 24. Injury to a client’s cell membrane has caused the local release of histamine. The nurse should anticipate what effect on the client? A) increased pain B) vasoconstriction C) decreases capillary permeability D) inhibition of phagocytosis

Ans: A

Feedback: Pain comes from the activation of pain fibers by histamine and the kinin system, occurring any time a cell is injured. Histamine also causes vasodilation, increases capillary permeability, and facilitates phagocytosis.

Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 258, Body Defenses 25. An adolescent presents to the clinic reporting allergic rhinitis. The adolescent asks the nurse to explain, “Why does my nose get so stuffy.” What is the nurse’s best response? A) “The inside of the nose swells because the blood vessels expand.” B) “Allergies make your sinuses drain into the nasal passages and it stuffs them up.” C) “The inside of your nose swells closed because of drainage from the sinuses.” D) “Cells called leukotrienes are attacking the mucous membranes of your nose and causing irritation.”

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Ans: A

Feedback: Histamine is the major mediator of allergic reactions in the nasal mucosa. Tissue edema results from vasodilation and increased capillary permeability. Tissue edema is not caused by drainage from the sinuses or from leukotrienes.

Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 265, Pathophysiology Involving the Immune System 26. A nurse asks a colleague who works in oncology why the body does not phagocytize a tumor. What would be the colleague’s best response? A) “Sometimes tumor cells trick the T cells into allowing them to survive.” B) “Some tumor cells do not develop an antigen–antibody reaction.” C) “Some tumor cells develop a strong mast cell reaction.” D) “Tumor cells are too small to be seen by the immune system.”

Ans: A

Feedback: Neoplasms occur when mutant cells escape normal surveillance of the immune system and begin to grow and multiply. Aging reduces efficiency of the immune system; location of mutant cells can make it difficult for lymphocytes to get to them or that mass can grow so quickly that the tumor becomes too large for the immune system to deal with. Tumors can produce antibodies that cover antigen receptor sites on the tumor and prevent recognition by cytotoxic T cells, or a weak antigenic tumor may elicit a mild response from the immune system and tricks the T cells into allowing it to survive.

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Format: Multiple Selection Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Page and Header: 258, Body Defenses 27. A client has tissue injury following the creation of a surgical incision. The nurse realizes that tissue injury will cause the activation of Hageman factor, leading to subsequent activation of what systems? Select all that apply. A) kinin system B) histamine release system C) clotting cascade D) plasminogen system E) chemotaxis system

Ans: A, C, D

Feedback: Hageman factor is responsible for activating at least three systems in the body: the kinin system; the clotting cascade, which initiates blood clotting; and the plasminogen system, which initiates the dissolution of blood clots. Histamine release is stimulated by cell damage. Arachidonic acid activates some leukotrienes that have a property called chemotaxis, which is the ability to attract neutrophils and to stimulate them and other macrophages to be very aggressive.

Format: Drag-and-Drop Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 258, Body Defenses; 261, Figure 15.2 28. When assessing the client with tissue injury, the nurse correlates signs and symptoms to the responses occurring within the client’s body. In what order will the inflammatory responses occur? 1) release of arachidonic acid 2) kininogen activates release of bradykinin 3) release of leukotrienes and prostaglandins 4) prekallikrein becomes kallikrein 5) activation of Hageman factor

Ans: 5, 4, 2, 1, 3

Feedback: Tissue injury is followed by exposure of plasma to the injured cell, which results in activation of Hageman factor. This stimulates prekallikrein to become active kallikrein. Kininogen activates bradykinin. Arachidonic acid is released, which activates release of leukotrienes and prostaglandins.

Format: Multiple Selection Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 258, Body Defenses 29. The nurse is describing the role of interferons to a client. What actions should the nurse explain? Select all that apply. A) preventing viral replication B) suppressing malignant cell replication

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C) suppressing tumor growth D) stimulating T and B cells to initiate an immune response E) stimulating the body to produce more T cells

Ans: A, B, C

Feedback: Interferons are chemicals that are secreted by cells that have been invaded by viruses and possibly by other stimuli. The interferons prevent viral replication and also suppress malignant cell replication and tumor growth. Interleukins stimulate T and B cells to initiate an immune response and to produce more T cells.

Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 265, Pathophysiology Involving the Immune System 30. The nurse is caring for a client waiting for a heart transplant. The client’s partner asks the nurse, “Why don’t they just choose any heart until the right heart can be found?” What is the nurse’s best response? A) “The more closely the new heart matches the client’s tissue, the less aggressive the immune reaction will be.” B) “When the body responds to specific self-antigens to produce antibodies against its own cells, a severe immune response results.” C) “Graft versus host disease would result making the client very ill.” D) “The client would need to have suppressor T cells infused daily to maintain the heart.”

Ans: A

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Feedback: Transplantation of foreign tissue (e.g., moving a heart from a donor to a sick client) results in an immune reaction. Matching a donor’s human leukocyte antigen markers is important as closely as possible to those of the recipient because histocompatibility is essential. The more closely the transplanted heart matches the recipient, the less aggressive the immune response will be to the donated tissue. Graft versus host disease occurs only in stem cell or bone marrow donations, not organ transplantation. Suppressor T cells cannot be transfused like blood because they must be produced by the body to function appropriately.

Format: Multiple Choice Chapter: 15 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 4 Page and Header: 258, Body Defenses 31. What is the meaning of the term dolor, when used to describe a characteristic of the inflammatory response? A) pain B) swelling C) redness D) heat

Ans: A

Feedback: The clinical presentation of an inflammatory reaction is heat (calor), redness (rubor), swelling (tumor), and pain (dolor).

Format: Multiple Selection Chapter: 15

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Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 258, Body Defenses 32. What autocoid helps moderate the frequency of rheumatoid arthritis flare-ups? Select all that apply. A) prostaglandins B) T lymphocytes C) leukotrienes D) cyclooxygenase E) thromboxanes

Ans: A, C

Feedback: Many inflammatory diseases, such as rheumatoid arthritis and systemic lupus erythematosus, are examples of these uncontrolled cycles. The prostaglandins and leukotrienes are important to the inflammatory response because they act to moderate the reaction, thus preventing this destructive cycle from happening on a regular basis. While cyclooxygenase and thromboxane are autocoid, neither have the capacity to block the inflammation process. T-lymphocytes are neutrophil cells that are involved in the phagocytic process.

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33. What is the primary difference between acute and chronic inflammation? A) Active inflammation is weaker in its response than the chronic form. B) The chronic form can stimulate cellular damage. C) Chronic inflammation is incapable of producing fibrotic tissue. D) The active form is much more painful than the chronic form.

Ans: B

Feedback: Unlike acute inflammation, chronic inflammation may last for weeks, months, or even years. It can be harmful by stimulating more cellular damage and even causing healthy tissue to become scarred and/or fibrotic. Acute inflammation is a response to cellular injury that can last from minutes to a few days. It is protective and part of the process of tissue healing. The response of active inflammation is not necessarily weaker than that of the chronic form nor is it more painful.

Test Generator Questions, Chapter 16, Antiinflammatory, Antiarthritis, and Related Agents Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 279, Acetaminophen 1. The nurse is assessing a 10-year-old child who has been experiencing chronic headaches. The child’s parent reports the administration of acetaminophen three to four times a day for the past several weeks. What assessment should the nurse prioritize? A) urine output, blood urea nitrogen, and creatinine B) liver enzymes C) breath sounds and oxygen saturation D) social support

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Ans: B

Feedback: The nurse should evaluate the client’s hepatic function. Severe hepatotoxicity can occur from overuse of acetaminophen. Significant interferences do not occur in the kidney and lungs with acetaminophen. Assessment of social support is always necessary, but liver damage presents the most acute threat to safety.

Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 270, Salicylates; 271, Table 16.1 3. A client, newly diagnosed with ulcerative colitis, has been admitted to the short-stay unit. The nurse should anticipate which medication will be ordered for this client? A) balsalazide B) fenoprofen C) choline magnesium trisalicylate D) salsalate

Ans: A

Feedback: Balsalazide is delivered intact to the colon, where it delivers a local antiinflammatory effect that is most effective for clients with ulcerative colitis. Fenoprofen is used for treatment of pain and arthritis in adults. Trisalicylate is used for pain, fever, and arthritis. Salsalate is used for pain, fever, and general inflammation.

Format: Fill-in-the-Blank

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Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 270, Salicylates; 271, Table 16.1 4. The nurse is caring for a 66-lb child prescribed choline magnesium trisalicylate. The prescription reads 50 mg/kg/d PO in two divided doses. How many 250-mg tablets should the nurse administer for each dose?

Ans: Three tablets

Feedback: First, the nurse must determine the child’s weight in kilograms. One kilogram is equal to 2.2 lbs. Divide 2.2 into 66 to equal 30 kg. Multiply 50 mg times 30 kg to equal 1,500 mg. Divide 1,500 by 2 for the divided doses, which will equal 750 mg per dose. Dividing 750 mg by 250 mg/tablet yields three tablets.

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C) metoprolol D) amoxicillin

Ans: C

Feedback: Nonsteroidal antiinflammatory drugs have the potential to decrease antihypertensive effects from beta-blockers (like metoprolol) if these drugs are taken at the same time. Clients who receive these combinations should be monitored closely and appropriate dosage adjustments made if needed. Drug interactions do not usually occur with oral antidiabetic agents (metformin), calcium channel blocking medications (amlodipine), or antibiotics (amoxicillin).

Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 273, Nursing Care Guide for G.T.: Rheumatoid Arthritis 6. A nurse is assessing a client who has been taking nonsteroidal antiinflammatory drugs (NSAIDs) for many months. What statement by the client indicates to the nurse that the client has a good understanding of the use of this therapy for their diagnosis of rheumatoid arthritis? A) “I’m careful not to eat grapefruit or drink grapefruit juice.” B) “I asked my doctor to check for blood in my stool regularly.” C) “I do not like to swallow whole tablets so I crush them.” D) “I drink as little water as possible when I take my medication so I don’t dilute their effect.”

Ans: B

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Feedback: Taking certain antiinflammatory drugs can irritate the gastric mucosa and increase the risk of bleeding; therefore, by asking the client’s provider to check their stool for bleeding, the nurse knows that the client is aware of this. Crushing the tablets can interfere with antiinflammatory metabolism. A full glass of water should be taken with this medication to increase absorption. Grapefruit juice does not interfere with NSAID metabolism.

Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3 Page and Header: 271, Box 16.1, Antiinflammatory Agents 7. Which adult client has the greatest risk for injury when using either salicylates or gold products? A) an older adult who experienced an MI B) a male diagnosed with prostate cancer C) a teenager diagnosed with an eating disorder D) a woman of childbearing age

Ans: D

Feedback: Clients who are pregnant or breastfeeding should not use these drugs unless the benefit clearly outweighs the potential risk to the fetus or neonate. Salicylates, NSAIDs, and gold products have potentially severe adverse effects on the neonate and possibly the parent. An older adult may be more susceptible to the CNS and GI effects of some of these drugs, but the risk may be minimized by adjusting the dosage. The risk to the male and teenage clients is similar to that of the general population.

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Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 4 Page and Header: 275, Nonsteroidal Antiinflammatory and Related Agents 8. A parent has brought a 6-year-old child to the clinic. The child has a fever of 102.8°F (39.3°C) and is subsequently diagnosed with the flu. What medication best balances risks and benefits for treating this client’s fever? A) etanercept B) penicillamine C) acetaminophen D) aspirin

Ans: C

Feedback: Acetaminophen would be the suggested medication. It is prescribed for relief of pain and fever for influenza in children. Aspirin would be contraindicated because it increases the risk for Reye’s syndrome. Etanercept and penicillamine are given for severe rheumatoid arthritis therapy.

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9. A nurse is presenting an educational event for a group of new parents. A participant has asked about the safe use of acetaminophen in children. What should the nurse teach the parents? A) “It’s best not to give acetaminophen to a child under 13 unless you receive a doctor’s order.” B) “Check the label of over-the-counter medications carefully to see if they include acetaminophen.” C) “Monitor your child’s temperature carefully and regulate the acetaminophen dose based on the fever.” D) “Mix OTC children’s medications to get the best coverage for your child’s symptoms, but make sure not to exceed the recommended dose of each medication.”

Ans: B

Feedback: Inadvertent overdose with acetaminophen frequently occurs because of the combining of OTC drugs that contain the same ingredients. Parents should be taught to carefully check the labels of OTC products and follow the dosage guidelines. A prescription is not required for acetaminophen. Dosage guidelines are the best guide to follow to prevent overdose; doses should not be “matched” to the severity of a fever.

Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1, 2 Page and Header: 279, Acetaminophen 10. A nurse has administered a prescribed dose of acetaminophen to a hospitalized client with a fever. This medication will reduce the client’s temperature by what means? A) blocking the increase of interleukin-1

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B) reacting with free-floating tumor necrosis (TNF) factor that is released by active leukocytes C) acting directly on the hypothalamus to cause vasodilation and sweating D) being taken up by macrophages, thus inhibiting phagocytosis and release of lysosomal enzymes

Ans: C

Feedback: Acetaminophen acts on the hypothalamus to cause vasodilation and sweating to reduce fever. The mechanism of action as an analgesic is not understood. Anakinra blocks the increased interleukin-1, which is responsible for the degradation of cartilage in rheumatoid arthritis. Etanercept reacts with free-floating TNF released by active leukocytes in autoimmune inflammatory disease to prevent the damage caused by TNF. Gold compounds are taken up by macrophages, which, in turn, inhibits phagocytosis and releases lysosomal enzymes, which causes damage associated with inflammation.

Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 285, Other Disease-Modifying Antirheumatic Drugs 11. A client has been diagnosed with severe rheumatoid arthritis and sodium hyaluronate has been ordered. What is the nurse’s best action? A) Teach the client that an intra-articular injection will be required. B) Establish intravenous access. C) Assess the client’s deltoid and ventrogluteal injection sites. D) Contact the health care provider to question the order.

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Ans: A

Feedback: Hyaluronidase derivatives (e.g., sodium hyaluronate) have elastic and viscous properties. These drugs are injected directly into the joints of clients with severe rheumatoid arthritis of the knee. IM and IV administration are not possible, and there is no obvious need to question the order.

Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 277, Nonsteroidal Antiinflammatory Drugs; 279, Prototype Summary: Ibuprofen 12. A nurse is caring for a client who has just been diagnosed with rheumatoid arthritis. What first-line treatment should the nurse anticipate? A) balsalazide B) ibuprofen C) ketorolac D) auranofin

Ans: B

Feedback: NSAIDs such as ibuprofen are indicated for relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis, for relief of mild to moderate pain, for treatment of primary dysmenorrhea, and for fever reduction. Balsalazide is used to treat ulcerative colitis. Ketorolac is used to treat acute pain in the short term. Auranofin is a gold salt that is not a first-line treatment.

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Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 285, Other Disease-Modifying Antirheumatic Drugs; 281, Table 16.3 13. The nurse is caring for a client who has just been prescribed anakinra for arthritis. What is the nurse’s best action? A) Confirm that the client’s peripheral IV is patent. B) Assess the integrity of the client’s oral mucosa. C) Obtain a 3-mL syringe with a 1¼″ , 21-gauge needle. D) Obtain a 1-mL syringe with a ½″, 26-gauge needle.

Ans: D

Feedback: Anakinra is administered subcutaneously every day and is often used in combination with other antiarthritis drugs. No other route is appropriate.

Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 275, Nonsteroidal Antiinflammatory and Related Agents; 272, Box 16.2 14. A 10-year-old client has been given OTC naproxen for the treatment of juvenile arthritis. What is the nurse’s best action? A) Contact the health care provider to question the order.

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B) Assess the client’s nutritional status prior to the first dose. C) Implement falls precautions. D) Encourage the client to maximize fluid intake.

Ans: A

Feedback: OTC versions of the medication should not be use for children <12 years of age without first consulting with the health care provider. This would be a priority over nutritional assessment and fluid promotion. There is no direct risk of falls associated with naproxen.

Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 275, Nonsteroidal Antiinflammatory and Related Agents; 276, Table 16.2 15. The nurse in the neonatal intensive care unit is assessing a neonate with patent ductus arteriosus. The nurse should anticipate the possible administration of which medication? A) penicillamine B) indomethacin C) balsalazide D) prednisone

Ans: B

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Feedback: Indomethacin given IV is used in premature infants to close a patent ductus arteriosus and avoid a surgical procedure. Penicillamine, balsalazide, and prednisone are not used for this purpose.

Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 280, Gold Compound 16. The nurse is caring for a client whose rheumatoid arthritis has not responded well to conventional therapies. The client’s health care provider has prescribed auranofin. What health education should the nurse provide? A) “Concurrent use of other NSAIDs is contraindicated.” B) “There is a possibility of significant and varied adverse effects.” C) “You must not receive any vaccinations during treatment due to the risk of a severe reaction.” D) “Weekly laboratory blood work will be necessary during the first 6 weeks of your treatment.” Ans: B

Feedback: Various adverse effects are common with the use of gold salts and are probably related to their deposition in the tissues and effects at that local level: stomatitis, glossitis, gingivitis, pharyngitis, laryngitis, colitis, diarrhea, and other GI inflammation; gold-related bronchitis and interstitial pneumonitis; bone marrow depression; vaginitis and nephrotic syndrome; dermatitis, pruritus, and exfoliative dermatitis; and allergic reactions ranging from flushing, fainting, and dizziness to anaphylactic shock. The use of other NSAIDs at the same time is not necessarily contraindicated, and there is no reason why the client cannot receive vaccinations. Weekly blood work is not required.

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Format: Multiple Selection Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 280, Gold Compound 17. A client diagnosed with rheumatoid arthritis is taking gold salts. The nurse should teach the client which drugs are contraindicated when taking gold salts? Select all that apply. A) antimalarials B) cytotoxic drugs C) salicylates D) penicillamine E) anticoagulants

Ans: A, B, D

Feedback: These drugs should not be combined with penicillamine, antimalarials, cytotoxic drugs, or immunosuppressive agents other than low-dose corticosteroids because of the potential for severe toxicity. No contraindication exists for therapy involving gold salts and salicylates or anticoagulants.

Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning

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Objective: 2 Page and Header: 273, Patient Teaching for G.T. 18. A client diagnosed with rheumatic disease is being prescribed salicylate therapy. The nurse should teach the client monitor for which adverse effects? A) ringing in the ears B) visual changes C) irritation of oral mucosa D) increased hair growth

Ans: A

Feedback: Tinnitus is associated with salicylates. The disease-modifying antirheumatic drug (DMARD) category of antimalarials may cause visual changes, GI upset, skin rash, headaches, photosensitivity, and bleaching of hair. Eighth cranial nerve damage and stomatitis are associated with gold therapy. Hirsutism is associated with corticosteroid therapy.

Format: Multiple Selection Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 270, Salicylates; 277, Nonsteroidal Antiinflammatory Drugs 19. The nurse should monitor laboratory results related to blood clotting when the client takes what drug(s) regularly? Select all that apply. A) salicylates B) nonsteroidal antiinflammatory drugs (NSAIDs) C) gold compounds D) acetaminophen E) disease-modifying antirheumatic drugs (DMARDs)

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Ans: A, B

Feedback: Salicylates and NSAIDs can both inhibit blood clotting resulting in bleeding if not monitored. Gold compounds, acetaminophen, and DMARDs do not have a known impact on blood clotting.

Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 280, Gold Compound 20. The nurse is reviewing the health record of a client with a prolonged history of rheumatoid arthritis. The health care provider’s notes state that the client may be an appropriate candidate for chrysotherapy. The nurse should anticipate what treatment? A) treatment involving intermittent application of hot and cold packs B) treatment with salicylates C) intra-articular injection of acetaminophen D) prescription for auranofin

Ans: D

Feedback: Chrysotherapy is the clinical name for treatment with gold salts in which gold is taken up by macrophages, which then inhibit phagocytosis. It is reserved for use in clients who are unresponsive to conventional therapy and can be very toxic. It is unrelated to treatment with hot/cold, acetaminophen, or salicylates.

Format: Multiple Choice

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Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 280, Gold Compound 21. A client with a history of severe rheumatoid arthritis has type 1 diabetes and early signs of diabetic nephropathy. The nurse should question the health care provider if what medication is prescribed? A) gold salts B) COX-2 inhibitors C) acetaminophen D) meclofenamate

Ans: A

Feedback: Gold salts can be extremely toxic and are contraindicated in the presence of any known allergy to gold, severe diabetes mellitus, congestive heart failure, severe debilitation, renal or hepatic impairment, hypertension, blood dyscrasias, recent radiation treatment, history of toxic levels of heavy metals, and pregnancy or lactation. COX-2 inhibitors, acetaminophen, and meclofenamate have no contraindications related to diabetes or kidney damage.

Format: Multiple Selection Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3

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Page and Header: 270, Antiinflammatory, Antiarthritis, and Related Agents; 271, Box 16.1 22. A nurse who provides care in a gerontologic setting works with many clients who have rheumatoid disorders and chronic pain. The nurse should question the health care provider if what antiinflammatories are prescribed for older adult clients? Select all that apply. A) sulindac B) indomethacin C) ketorolac D) naproxen E) ketoprofen

Ans: C, D, E

Feedback: Geriatric warnings have been associated with naproxen, ketorolac, and ketoprofen because of reports of increased toxicity when they are used by older clients. These nonsteroidal antiinflammatory drugs should be avoided if possible. Sulindac and indomethacin are not associated with toxicity in older clients.

Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 273, Patient Teaching for G.T. 23. A client with a history of chronic pain related to rheumatoid arthritis presents at the emergency department reporting dizziness, mental confusion, and difficulty hearing. What assessment is most appropriate? A) Assess the client’s allergy status. B) Assess the client for recent exacerbations of rheumatoid arthritis.

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C) Assess the client’s use of salicylates. D) Assess the client’s use of acetaminophen.

Ans: C

Feedback: Salicylism can occur with high dosage of aspirin. Dizziness, ringing in the ears, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, and lassitude can occur. This combination of adverse effects is not associated with acetaminophen toxicity or an exacerbation of rheumatoid arthritis itself. This constellation of symptoms is not suggestive of an allergic reaction.

Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 273, Patient Teaching for G.T. 24. A parent brings their 3-year-old child to the emergency department telling the nurse that the child has gotten into a bottle of baby aspirin. The parent estimates that there were between fifteen and twenty 81-mg tablets in the bottle, which is now empty. The nurse should anticipate what treatment? A) administration of syrup of ipecac B) gastric lavage C) watchful waiting and supportive care D) administration of naloxone as prescribed

Ans: C

Feedback: Acute salicylate toxicity may occur at doses of 20 to 25 g in adults or 4 g in children. This child has ingested less than around 1,600 mg, so would likely be

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monitored. Syrup of ipecac is no longer used clinically. Gastric lavage would not likely be indicated. Naloxone is used for opioid, not salicylate, overdose.

Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 275, Nonsteroidal Antiinflammatory and Related Agents; 276, Table 16.2 25. The nurse is caring for a client with joint pain whose primary health care provider has recommended the use of ibuprofen 400 mg PO t.i.d. What is the nurse’s best response to this prescription? A) Offer to help the client investigate alternative therapies. B) Contact the provider to confirm the frequency. C) Contact the provider to confirm the dose. D) Educate the client about possible adverse effects.

Ans: D

Feedback: This order is appropriate with regard to dose and frequency. In most circumstances, it is inappropriate for the nurse to initiate the exploration into alternatives to treatments that have been prescribed. Education about potential adverse effects is necessary to ensure safety.

Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Easy Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 277, Nonsteroidal Antiinflammatory Drugs 26. An older adult client has presented to the emergency department reporting frank blood in their stool over the past 24 hours. What assessment question should the nurse prioritize? A) “What medications do you take for pain or inflammation?” B) “Have you ever been diagnosed with rheumatoid arthritis?” C) “Have you ever been diagnosed with kidney disease of any kind?” D) “Have you taken any medications for a fever lately?

Ans: A

Feedback: NSAIDs are associated with a risk for GI bleeding. Many of these medications are taken for rheumatoid arthritis, but this is not necessarily the case. Renal failure is unassociated with GI bleeding. Many clients take NSAIDs for a fever, but this normally entails short-term use, which is much less likely to cause GI bleeding.

Format: Multiple Selection Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 277, Nonsteroidal Antiinflammatory Drugs 27. The clinic nurse is caring for a client who is taking a COX-2 inhibitor. The nurse should perform what related assessments? Select all that apply. A) Monitor laboratory results related to coagulation. B) Monitor liver enzyme levels. C) Assess hearing acuity.

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D) Assess for gastrointestinal (GI) effects. E) Assess for fluid volume excess.

Ans: A, D, E

Feedback: COX-2 inhibitors have an impact on many body functions, and clients receiving this therapy should be assessed for GI effects, changes in bleeding time, and water retention. Clients taking COX-2 inhibitors do not need to be evaluated for liver function or altered hearing because these are not common adverse effects.

Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 282, Disease-Modifying Antirheumatic Drugs 28. A client with severe rheumatoid arthritis has been prescribed etanercept. What health education should the nurse provide to this client? A) technique for subcutaneous self-injection B) risks of pneumonia and pulmonary infiltrates C) risks of gastrointestinal bleeding D) use of the specialized inhaler for etanercept

Ans: A

Feedback: Etanercept is administered subcutaneously, often by the client in an outpatient setting. There are serious adverse effects possible, but these do not normally include respiratory or GI effects. Etanercept is not inhaled.

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Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 277, Nonsteroidal Antiinflammatory Drugs 29. A client’s current drug regimen includes a nonsteroidal antiinflammatory drug (NSAID) and a loop diuretic. What assessment should the nurse consequently prioritize? A) heart rate B) blood pressure C) cognition D) assessment for signs of bleeding

Ans: B

Feedback: Diuretic effect is often decreased when NSAIDs are taken with loop diuretics, negating any desired decrease in blood pressure. This particular drug combination does not cause unusual changes in heart rate, cognition, or coagulation.

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30. The nurse is caring for a client who reports taking 800 mg of ibuprofen three times a day for relief of menstrual cramps. What laboratory results should the nurse prioritize when assessing this client? A) complete blood count B) white blood cell differential C) electrolytes D) cholesterol and triglyceride profile

Ans: A

Feedback: Ibuprofen, like all nonsteroidal antiinflammatory drugs, can cause irritation to the GI mucosa and block platelet clumping, both of which can result in bleeding. Blood loss due to dysmenorrhea can exacerbate these risks so it is important to assess the complete blood count to monitor for excessive blood loss. White blood cell differential would be impacted by infection, which is not indicated here. Electrolytes, cholesterol, and triglyceride levels would not be impacted by ibuprofen.

Format: Multiple Selection Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 277, Nonsteroidal Antiinflammatory Drugs; 278, Box 16.3 31. What is the current recommendation by the World Health Organization (WHO) regarding the risks and benefits of taking NSAIDs to manage the symptoms of COVID19? Select all that apply. A) People already prescribed NSAIDs should continue their therapy if they contract COVID-19. B) Studies strongly suggest NSAIDs should be avoided because of their binding effect on SARS-CoV-2.

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C) NSAIDs may be taken to relieve symptoms of COVID-19. D) NSAID use is recommended due to the inhibiting effect it has on prostaglandin. E) The WHO has yet to make a recommendation regarding the use of NSAIDs in this application. Ans: A, C

Feedback: At this time in 2022, the World Health Organization has recommended that clients who are prescribed NSAIDs continue their therapy. In addition, people suffering from symptoms of COVID-19 may take either acetaminophen or NSAIDs to relieve symptoms. Some theorize that the use of NSAIDs may worsen the infection due to increased activity of the enzyme that SARS-CoV-2 binds to in order to enter human cells. However, others hypothesize that NSAIDs would be helpful in relieving inflammatory symptoms by inhibiting prostaglandin and proinflammatory cytokines, including interleukin-6 overproduction. This interleukin is thought to be related to the cytokine release syndrome that some clients suffer from when they have COVID-19. The studies completed through 2021 have some contradictory information regarding the risks and benefits, and more studies are underway.

Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 275, Nonsteroidal Antiinflammatory and Related Agents; 276, Table 16.2 32. A client with lower back pain has been recommended a topical NSAID to be applied at the site of pain. The nurse anticipates which likely prescription by the health care provider? A) naproxen B) diclofenac

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C) etanercept D) sodium hyaluronate

Ans: B

Feedback: Diclofenac is available in a topical patch form, unlike naproxen, etanercept, and sodium hyaluronate.

Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 5 Page and Header: 285, Other Disease-Modifying Antirheumatic Drugs; 281, Table 16.3 33. The nurse is teaching the client, who has been newly prescribed etanercept, how to administer the medication. What statement is accurate? A) “Be sure to drink a whole glass of water when swallowing the pill.” B) “Do not take this medication for at least 1 hour after taking an antacid.” C) “You can rotate subcutaneous injection sites to avoid tissue damage.” D) “Inject this medication deeply into the muscle to promote absorption.”

Ans: C

Feedback: Etanercept is given by injecting it into the subcutaneous tissues. The injection sites should be rotated to avoid tissue damage. Because it is not taken orally, there is no requirement related to amount of water to be taken or waiting an hour after taking an antacid. Etanercept is not injected into the muscle but rather into the subcutaneous tissue.

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Format: Multiple Choice Chapter: 16 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 275, Nonsteroidal Antiinflammatory and Related Agents; 271, Box 16.1 34. The pediatric client has a fever and the nurse is preparing to administer an antipyretic. What drug would be the best choice for this client? A) balsalazide B) naproxen C) indomethacin D) acetylsalicylic acid

Ans: B

Feedback: Naproxen is approved for pediatric use and has antipyretic properties. Balsalazide is used to treat ulcerative colitis and would not be appropriate for treating a fever. Indomethacin has antiinflammatory effects but does not have antipyretic effects. Aspirin would not be appropriate for treating a child with a fever of unknown origin due to risk of Reye’s syndrome.

Test Generator Questions, Chapter 17, Immune Modulators Format: Multiple Choice Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Teaching/Learning Objective: 5 Page and Header: 292, Immune Stimulants 1. A client diagnosed with hairy cell leukemia has been prescribed interferon alfa-2b. What health education should the nurse provide to this client? A) Drinking alcohol while taking the drug can cause serious adverse effects. B) Continue to maintain maximal physical activity. C) Increase fluid intake while taking the drug. D) Constipation is likely and can be treated with over-the-counter laxatives.

Ans: C

Feedback: Interferon alfa-2b is partially metabolized in the kidney so adequate fluid intake is needed to promote metabolism and excretion of the drug as well as to minimize common adverse effects including dry skin and dizziness. Maintaining maximal physical activity is a good idea but has no relationship to the use of the drug. Constipation is not an associated adverse effect of this medication. There is no absolute contraindication against alcohol, and it is not linked to particular adverse effects.

Format: Multiple Choice Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 292, Immune Stimulants; 294, Table 17.1 2. A client has a large facial wart that is causing an impaired body image. The health care provider has prescribed an injection of an interferon directly into the client’s wart. What interferon should the nurse prepare? A) interferon alfa-2a B) interferon alfacon-1

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C) interferon alfa-n3 D) interferon beta-1a

Ans: C

Feedback: Interferon alfa-n3 is used for intralesional treatment of warts. Interferon alfa-2a is used in the treatment of leukemia. Interferon alfacon-1 is used in the treatment of chronic hepatitis C infection in adults. Interferon beta-1a is used to treat multiple sclerosis in adults.

Format: Multiple Choice Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 297, Immune Suppressants 3. A 30-year-old female has been diagnosed with leukemia and will be using an immune modulator for treatment. What should the nurse teach the client about their drug therapy? A) The client should continue to use their prescribed oral contraceptives. B) The client should use barrier contraceptives while taking the drug. C) The client should abstain from sexual intercourse while taking the drug. D) Immune modulators will likely cause dysmenorrhea.

Ans: B

Feedback: A client taking an immune modulator would be advised to use barrier contraceptives to prevent pregnancy. The interaction of the immune modulator and the oral contraceptive may interfere with the oral contraceptive’s ability to work properly.

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Asking clients to avoid sexual intercourse is not necessary if barrier methods are properly used. Immune modulators do not cause dysmenorrhea.

Format: Multiple Choice Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 292, Immune Stimulants 4. The nurse has a prescription to administer oprelvekin to a client for the first time. Before administering the drug, what assessment should the nurse perform? A) Assess the client for any history of ischemic heart disease. B) Assess for allergy to Escherichia coli–produced products. C) Assess for lactose intolerance. D) Assess the client’s baseline hepatic function.

Ans: B

Feedback: The interleukins are produced using deoxyribonucleic acid technology and E. coli bacteria. Clients with known allergy to E. coli products should not receive oprelvekin. Lactose intolerance is not clinically problematic. The drug has minimal impact on hepatic function, and a history of ischemic heart disease does not contraindicate its use.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 5 Page and Header: 292, Introduction 5. An older adult client who is receiving an immune suppressant has been admitted to the hospital unit. What action should the nurse prioritize? A) monitoring the client’s nutritional status B) providing client teaching regarding pharmacokinetics C) protecting the client from infection D) providing support and comfort measures related to adverse effects

Ans: C

Feedback: Older adult clients taking immune suppressant drugs are more susceptible to infection because the client’s normal body defenses will be diminished. As a result, the priority action by the nurse would to protect the client from exposure to infection through room selection, good hand hygiene, and taking care to avoid exposure to sick staff members. Nutritional status is important, as are comfort and support measures and other instructions concerning the drug. However, protecting the client from infection should be the priority action because this involves client safety.

Format: Multiple Choice Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 292, Immune Stimulants 6. A nurse is discussing interferon alfa-2b with a client who has been prescribed the drug for a diagnosis of chronic hepatitis C. What health education should the nurse provide to the client? A) The drug may cause flulike symptoms. B) Avoid salt substitutes and high-potassium foods during treatment.

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C) Avoid drinking grapefruit juice for the duration of treatment. D) Eat four or five smaller meals a day rather than three larger meals.

Ans: A

Feedback: The adverse effects associated with the use of interferons are related to the immune or inflammatory reaction that is being stimulated (stimulating the immune and inflammatory response causes a flulike syndrome with lethargy, myalgia, arthralgia, anorexia, nausea). Grapefruit juice is not contraindicated, and there is no particular need to eat small, frequent meals. There is no need to deliberately avoid sources of potassium.

Format: Multiple Choice Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 292, Immune Stimulants 7. A 77-year-old client diagnosed with acute myelocytic leukemia has been prescribed sargramostim. What is a priority nursing action for this client? A) providing a quiet environment B) ensuring adequate fluid intake C) providing comfort measures related to anxiety D) encouraging appropriate dietary intake

Ans: B

Feedback: A common adverse effect of this drug is vomiting and diarrhea. Due to the client’s age, it would be important to keep them hydrated. Vomiting and diarrhea can cause dehydration quickly in older adults. Providing a quiet environment and comfort

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measures for possible anxiety would be important but not as critical as increasing fluids. Diet is very important to this client; however, usually this drug causes a loss of appetite. Therefore, increasing fluids would be extremely important to the client’s nutritional status. Fluid balance is more volatile than nutritional status.

Format: Multiple Selection Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 5 Page and Header: 297, Immune Suppressants 8. The nurse is caring for a client in the immediate postoperative period following cardiac transplantation. The client is receiving mycophenolate IV. What should the nurse teach the client regarding drug therapy? Select all that apply. A) “The drug will be given orally as soon as possible.” B) “You’ll be given this medication four times a day.” C) “It’s important to avoid people with contagious diseases.” D) “Ask a pharmacist about drug–drug interactions before taking any over-the-counter (OTC) drug once you’re discharged.” E) “Never miss a dose of medication.”

Ans: A, C, D, E

Feedback: The nurse will explain that the IV medication will be changed to oral therapy when the client is able to tolerate oral medications. The client will take the medication twice a day, not three times a day. Care should be taken to never miss a dose. The client should avoid other medications that are hepatotoxic or nephrotoxic due to a risk of increased toxicity so that the client should be taught to always consult a provider or pharmacist before beginning an OTC drug. Clients who have immune suppression must

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be taught how to reduce risk of infection, including avoiding people with contagious diseases, such as colds or viruses.

Format: Multiple Selection Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 292, Immune Stimulants 9. The nurse administers aldesleukin to a client diagnosed with renal cell carcinoma. When assessing the client 5 days later, what abnormal findings should the nurse most likely attribute to the medication? Select all that apply. A) increased lymphocyte count B) increased red blood cell count C) increased platelet count D) irregular pulse rate E) increased blood pressure

Ans: A, C, D

Feedback: Aldesleukin activates human cellular immunity and inhibits tumor growth through increases in lymphocytes, platelets, and cytokines. Common adverse effects include hypotension, sinus tachycardia, arrhythmias, as well as pruritus, nausea, vomiting, diarrhea, anorexia, GI bleeding, bone marrow suppression, respiratory difficulties, fever, chills, pain, mental status changes, and dizziness. There is no impact on red blood cell count. It does not raise blood pressure.

Format: Multiple Choice Chapter: 17

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 1, 4 Page and Header: 292, Immune Stimulants 10. Which client would be most likely to benefit from interferon treatment? A) a pediatric client with bacterial meningitis B) a client who successfully received a renal transplant 6 months ago C) a client who has just received a stem cell transplant D) an adult client with a diagnosis of chronic hepatitis B

Ans: D

Feedback: Interferons are substances naturally produced and released by human cells that have been invaded by viruses. They are not used to prevent rejection associated with solid organ transplants or immunosuppression related to bone marrow transplant. They are not indicated in the treatment of bacterial infections.

Format: Multiple Choice Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 292, Introduction 11. How do immune suppressants work when ordered for a client who has had an organ transplant? A) blocking normal effects of the immune system B) stimulating immune system to fight off infection C) working with corticosteroids to enhance healing

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D) working with corticosteroids to promote suppressor cells

Ans: A

Feedback: Immune suppressants are used to block the normal effects of the immune system in cases of organ transplantation (in which non–self-cells are transplanted into the body and destroyed by the immune reaction) and in autoimmune disorders (in which the body’s defenses recognize self-cells as foreign and work to destroy them) in some cancers. They do not stimulate immune function or directly enhance healing and suppressor cell function.

Format: Multiple Choice Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 4 Page and Header: 292, Immune Stimulants 12. A client has just been told that their cancer has metastasized to the right kidney. An interferon (aldesleukin) has been prescribed to treat this metastasis. What potential benefit should the nurse describe to the client? A) enhancement of renal function B) inhibition of tumor growth C) protection against opportunistic infection D) enhancement of antibody function

Ans: B

Feedback: Aldesleukin is prescribed for metastatic renal cell carcinoma in adults and treatment of metastatic melanomas (orphan drug use) working by activating human cellular immunity and inhibiting tumor growth through increases in lymphocytes,

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platelets, and cytokines. Aldesleukin does not directly enhance renal or antibody function, nor does it confer protection against infection.

Format: Multiple Choice Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Page and Header: 292, Immune Stimulants 13. The nurse admits a client who was newly diagnosed with Kaposi’s sarcoma to the unit. The health care provider has ordered an IV infusion of an interferon. What drug should the nurse anticipate? A) interferon beta-1a B) interferon gamma-1b C) interferon alfa-2b D) peginterferon alfa-2b

Ans: C

Feedback: Interferon alfa-2b indications include hairy cell leukemia, melanoma, AIDSrelated Kaposi’s sarcoma, chronic hepatitis B and C infection, and intralesional treatment of condyloma acuminatum in clients 18 years of age or older. No other interferons are explicitly indicated for treatment of Kaposi’s sarcoma.

Format: Multiple Selection Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult

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Integrated Process: Nursing Process Objective: 4 Page and Header: 292, Immune Stimulants 14. What clients are likely to benefit from treatment with interferons? Select all that apply. A) an adult client with nephropathy secondary to type 1 diabetes B) an older adult client who has viral pneumonia C) an adult client with multiple sclerosis D) an adult client who has chronic hepatitis C E) an adult client who has breast cancer with lung metastases

Ans: C, D

Feedback: Interferons have proven benefits for clients who have hepatitis C and multiple sclerosis. They are not normally used to treat breast cancer, lung cancer, viral pneumonia, or diabetic nephropathy.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 297, Immune Suppressants 15. A client on the transplant unit is taking cyclosporine after receiving a liver transplant 4 days earlier. A coworker of the client has come for a visit and is apologetic because of a cough and runny nose. What is the nurse’s best action? A) Tell the visitor that it would be inappropriate to visit the client at this time. B) Teach the visitor to perform thorough hand hygiene and provide them with a mask. C) Provide the visitor with a gown, gloves, and mask before they enter the room.

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D) Teach the visitor about the client’s risk for infection and ask the visitor to return after becoming healthy.

Ans: D

Feedback: Due to the fact that the client is immunocompromised, an ill visitor should be discouraged from visiting, regardless of whether the individual uses standard precautions. However, the nurse should complement this directive with education about its rationale.

Format: Multiple Choice Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 297, Immune Suppressants 16. A 2-year-old client is immunocompromised following treatment for leukemia, and the client’s sibling has developed respiratory syncytial virus (RSV). What medication will best prevent RSV in the client? A) palivizumab B) natalizumab C) belimumab D) eculizumab

Ans: A

Feedback: Palivizumab is specific to the antigenic site on respiratory syncytial virus (RSV); it inactivates that virus. It is used to prevent RSV disease in high-risk children. Natalizumab is an antibody specific to surface receptors on all leukocytes except neutrophils. Belimumab is a specific inhibitor of B-lymphocyte stimulator that inhibits the survival of B lymphocytes and their differentiation into immunoglobulin producing cells.

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Eculizumab binds to complement proteins and prevents the formation of the complement complex.

Format: Fill-in-the-Blank Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 297, Immune Suppressants 17. The nurse is caring for an adult client with colon cancer. The client has been prescribed cetuximab 400 mg/m2 IV to be administered over 2 hours. The client’s body surface area is 1.85 m2. How many milligrams of cetuximab should the nurse administer? Round your answer to a whole number.

Ans: 740 mg

Feedback: The client’s dose is determined by multiplying 400 mg by the client’s body surface area measured in m2. This yields 740 mg.

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18. The nurse is providing care for a client diagnosed with chronic hepatitis C. The client has recently been prescribed peginterferon alfa-2b. What is the nurse’s most appropriate action? A) Teach the client about the importance of sitting upright for at least 30 minutes after taking the drug. B) Arrange for the client to have a peripherally inserted central catheter (PICC) placed. C) Teach the client how to self-administer subcutaneous injections. D) Assess the client’s baseline respiratory function.

Ans: C

Feedback: Peginterferon alfa-2b is given by weekly subcutaneous injections, so it is likely that the client will be self-administering. IV access is unnecessary, and the drug is not available for oral administration. Respiratory adverse effects are not normally encountered.

Format: Multiple Choice Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 4 Page and Header: 297, Immune Suppressants 19. A client’s health care provider has concluded that the client is likely to benefit from treatment with a monoclonal antibody. The success or failure of treatment will primarily depend on what variable? A) the match between target cell receptor sites and the monoclonal antibody B) successful stimulation of the client’s humoral immune system C) the client’s adherence to the prescribed treatment regimen D) the response of the client’s cell-mediated immune system to the monoclonal antibody

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Ans: A

Feedback: Monoclonal antibodies are each specific to target cell receptor sites. If these do not match, treatment will not be successful, even if the client closely adheres to the treatment plan. Monoclonal antibodies do not directly stimulate the client’s own immune function.

Format: Multiple Choice Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Page and Header: 297, Immune Suppressants 20. The nurse is caring for an adult client who has not responded to traditional antirheumatic drugs. The nurse should anticipate the administration of what interleukin receptor antagonist? A) natalizumab B) anakinra C) eculizumab D) adalimumab

Ans: B

Feedback: Anakinra is used to reduce the signs and symptoms of moderately to severely active rheumatoid arthritis in clients 18 years of age and older who have not responded to the traditional antirheumatic drugs. Each of the other options are monoclonal antibodies, not interleukin receptor antagonists.

Format: Multiple Choice Chapter: 17

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 292, Immune Stimulants 21. A client has undergone bone marrow transplant for the treatment of multiple myeloma. The client has been prescribed filgrastim 6 mcg/kg IV daily. What outcome should indicate successful medication therapy to the nurse? A) The client remains free of infection. B) The client’s platelet, red cell, and white cell indices rise. C) The client’s multiple myeloma goes into remission. D) The client’s Kaposi’s sarcoma resolves.

Ans: A

Feedback: Filgrastim is a colony-stimulating factor that is given to reduce infection risk in immunocompromised clients. It is not a direct treatment for the client multiple myeloma, and it is not given to treat active Kaposi’s sarcoma. Resolution of neutropenia would be expected, but there is no expected effect on thrombocyte and erythrocyte levels.

Format: Multiple Choice Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 297, Immune Suppressants 22. The client has arrived in the short stay unit for an infusion of iodine-131 tositumomab. Before beginning the infusion, the nurse assesses the client’s vital signs

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and finds the client has a temperature of 101.5°F (38.6°C). What is the nurse’s best action? A) Administer the infusion as ordered in order to treat the fever. B) Administer the infusion at one-half of the usual rate. C) Document the assessment finding. D) Treat the fever as ordered before beginning the therapy.

Ans: D

Feedback: Monoclonal antibodies should be used cautiously with fever; the nurse should treat the fever before beginning therapy. This finding should certainly be documented, but this is not a sufficient response on its own.

Format: Multiple Choice Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 2, 5 Page and Header: 297, Immune Suppressants 23. A 72-year-old client has arrived at the outpatient unit to receive an infusion of alemtuzumab . The client tells the nurse that this is the second time their chronic lymphocytic leukemia has relapsed, and it is the second time they will receive this drug because they failed alemtuzumab therapy after being treated with an alkylating agent. What is the priority nursing action? A) Confirm the order with the health care provider. B) Perform a comprehensive assessment. C) Document the statement and initiating an intravenous infusion. D) Validate the client’s fears about another failed treatment.

Ans: A

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Feedback: Monoclonal antibodies should be used cautiously in clients who have had previous administration of the monoclonal antibody (serious hypersensitivity reactions can occur with repeat administration). The nursing priority would be to question the order because the client has already received alemtuzumab previously, and if the order is verified, this client should be monitored very carefully, perhaps starting to infuse more slowly until the client’s reaction can be determined. Communicating with the provider is a safety priority and would be more important than validating the client’s fears or performing a comprehensive assessment.

Format: Multiple Choice Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 297, Immune Suppressants 24. The nurse is writing a plan of care for a client receiving immune suppressants for leukemia. What would be an appropriate nursing conclusion for this client? A) impaired skin integrity related to stomatitis B) acute pain related to gastrointestinal (GI) and flulike effects C) impaired urinary elimination related to peripheral nervous system disruption D) imbalanced nutrition: more than body requirements related to adverse GI effects

Ans: B

Feedback: Nursing diagnoses related to drug therapy might include: acute pain related to CNS, GI, and flulike effects. Imbalanced nutrition would be less than body requirements due to flulike symptoms resulting in diminished appetite. Stomatitis and impaired elimination do not typically occur.

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Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 297, Immune Suppressants 25. The nurse is preparing a client to receive immunosuppressant drugs on an outpatient basis. The nurse recognizes which action is the priority? A) Arrange a caregiver who is skilled in cardiopulmonary resuscitation (CPR). B) Arrange a caregiver who will be able to be with the client at all times, day and night. C) Arrange a caregiver who can monitor the client’s health status and provide social support. D) Arrange a caregiver who can meet the client’s spiritual and cultural needs.

Ans: C

Feedback: The client benefits from a caregiver who can monitor their health status as well as meeting psychosocial needs. A person who can perform CPR is beneficial, but the client’s needs go beyond this single skill. Similarly, spiritual and cultural support is beneficial, but practical and health-related skills are needed as well. The client does not need to be continually supervised.

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Page and Header: 292, Immune Stimulants 26. The nurse is caring for a client who has a diagnosis of chronic hepatitis B infection and has been prescribed an immune stimulant. After teaching the client about the treatment plan, how should the nurse evaluate the effectiveness of teaching? A) Ask the client if they understand everything the nurse described. B) Ask the client to summarize the risk factors for hepatitis B. C) Ask the client if they have any more questions. D) Ask the client to describe specific measures to avoid adverse effects.

Ans: D

Feedback: The nurse would evaluate that the teaching plan was successful if the client can name drug, dosage, adverse effects to watch for, and specific measures to avoid adverse effects. Offering to answer questions and asking if the client understands do not evaluate learning. Having the client describe characteristics of hepatitis B does not evaluate learning about therapy.

Format: Multiple Choice Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 297, Immune Suppressants 27. The nurse is caring for a client who had a renal transplant 24 hours ago and is receiving mycophenolate IV as prescribed. What goal should be set for this client’s subsequent care? A) transitioning to the oral route as soon as possible B) weaning the client off mycophenolate within 96 hours C) weaning the client off mycophenolate within 10 days D) teaching the client to self-administer mycophenolate IV

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Ans: A

Feedback: Mycophenolate is often begun by the IV route, with a transition to oral delivery as soon as practical. It must be taken long term.

Format: Multiple Choice Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 292, Immune Stimulants 28. The nurse is caring for a client who is to receive interleukins. What change in the client’s status would most clearly suggest successful therapy? A) increased neutrophil levels B) increased numbers of natural killer cells C) decreased C-reactive protein level D) increased basophil levels

Ans: B

Feedback: When interleukins are administered, there are increases in the numbers of natural killer cells and lymphocytes, in cytokine activity, and in the number of circulating platelets. They do not affect leukocyte or C-reactive protein levels.

Format: Multiple Choice Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 297, Immune Suppressants 29. The nurse is caring for a child requiring cyclosporine to prevent rejection. Cyclosporine is given to adults using a dosage of 15 mg/kg. The nurse calculates the child’s dosage is 20 mg/kg. What is the nurse’s priority action? A) Administer the drug as prescribed. B) Hold the dose and question the ordering provider. C) Complete an incident report if this dosage has already been given before. D) Notify the nursing supervisor of the medication error.

Ans: A

Feedback: The nurse would administer the medication as ordered because doses larger than those given to adults are often needed when cyclosporine is administered to children. This is not an error so the nurse would not hold the drug, question the provider, complete an incident report, or notify the nursing supervisor.

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D) Minimize teaching to avoid causing confusion. E) Encourage the family to visit often, especially young children.

Ans: A, B, C

Feedback: Older clients may be more susceptible to the effects of the immune modulators, partly because the aging immune system is less efficient and less responsive. These clients need to be monitored closely for infection, GI, renal, hepatic, and central nervous system effects. Baseline renal and liver function tests can help to determine whether a decreased dosage will be needed before beginning therapy. Because these clients are more susceptible to infection, they need to receive extensive teaching, not less teaching, about ways to avoid infection and injury. Contact with young children and large groups of people increase the risk of infection.

Format: Multiple Choice Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 292, Immune Stimulants 31. The nurse teaches a female client who is receiving immune modulating drugs about the need to use barrier contraceptives. The client says, “I hate using barrier contraceptives. Why can’t I just take oral contraceptives?” What is the nurse’s best response? A) “Effects of oral contraceptives may be altered by liver changes or changes in immune response.” B) “Oral contraceptives increase the action of immune modulating drugs so dosage needs to be reduced.” C) “Immune modulators make oral contraceptives ineffective because of hormonal impact of drugs.”

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D) “Oral contraceptives are acceptable if barrier contraceptives are distasteful, but only high-estrogen pills can be used.”

Ans: A

Feedback: The use of barrier contraceptives is advised because the effects of oral contraceptives may be altered by liver changes or by changes in the body’s immune response, potentially resulting in unexpected pregnancy. The other options conflict with this information and are incorrect.

Format: Multiple Choice Chapter: 17 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Difficult Integrated Process: Communication and Documentation Objective: 3 Page and Header: 292, Immune Stimulants 32. The nurse is caring for a young adult female taking immune modulating medications who has been advised to use barrier contraceptives, but the client wants to start a family. What information can the nurse provide about these drugs to help this client with decision-making? A) “Discuss your desire to start a family with the provider so risk can be minimized.” B) “Immune modulating drugs will need to be discontinued if pregnancy occurs.” C) “Immune modulating drugs have been proven to be highly teratogenic.” D) “Pregnancy is not an option when taking immune modulating drugs, but adoption is an option.”

Ans: A

Feedback: If a client taking immune modulators becomes pregnant or decides that they want to become pregnant, the client should discuss this with their health care provider

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and review the risks associated with use of the drug or drugs being taken. Monoclonal antibodies should be used with caution during pregnancy and lactation. Because results of long-term studies of most of these drugs are not yet available, it may be prudent to advise clients taking these drugs to avoid pregnancy if possible. Immune modulating drugs do not need to be discontinued, but the safest drug should be prescribed. Most immune modulating drugs have not been studied, and there is not enough information to know whether they are teratogenic. The nurse cannot tell a client that pregnancy is not an option.

Format: Multiple Choice Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 297, Immune Suppressants 33. The nurse is caring for a client diagnosed with rheumatoid arthritis (RA) who recently underwent a liver transplant. What immunosuppressant could this client be prescribed that would treat both conditions? A) anakinra B) adalimumab C) sirolimus D) cyclosporine

Ans: A

Feedback: Anakinra is used to prevent rejection after kidney or liver transplantation and also reduces signs and symptoms of RA in clients who have had inadequate response to other drugs. Adalimumab would be effective for the client’s RA but would not prevent rejection of the transplanted liver. Sirolimus is used to prevent rejection of

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kidney transplants but would not be effective for either of the client’s diagnoses. Cyclosporine would be appropriate to prevent liver rejection but would not treat RA.

Format: Multiple Choice Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 293, Children 33. Which child receiving an immune modulator presents the greatest risk for injury? A) a 6-month-old child with a family history of asthma B) an 18-month-old child enrolled in day care C) a 5-year old child that is immobile due to a genetic bone disorder D) a 10-year old child who is on the school’s soccer team

Ans: D

Feedback: Protecting the child from infection and injury is a very important part of the care of a child taking an immune modulator. This can be a great challenge with an active child. The most physically active child, and so at greatest risk for injury, is the 10-yearold soccer player.

Format: Multiple Choice Chapter: 17 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 3

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Page and Header: 293, Box 17.1 Focus on Drug Therapy across the Lifespan, Immune Modulators 34. Which consideration associated with the older adult client has priority when considering their care needs while on immune modulator therapy? A) effects of normal aging B) impact of impaired mobility C) results of sensory deficiencies D) presence of chronic illness

Ans: A

Feedback: Older clients may be more susceptible to the effects of the immune modulators, partly because the aging immune system is less efficient and less responsive. While all the options should be considered, the immune modulator therapy will be a specific risk to this client and will require client-centered care interventions.

Test Generator Questions, Chapter 18, Vaccines and Sera Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 312, Immunity 1. The public health nurse is reviewing immunity with a group of school nurses prior to an immunization campaign. What should the public health nurse teach this group of school nurses? A) Active immunity occurs with injected antibodies that react with specific antigens.

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B) Serum sickness results when the body fights antibodies injected as a form of active immunity. C) Passive immunity occurs when foreign proteins are recognized and the body produces antibodies. D) Passive immunity is limited, lasting only as long as the antibodies circulate.

Ans: D

Feedback: Unlike active immunity, passive immunity is limited. It lasts only as long as the circulating antibodies last because the body does not produce its own antibodies as found in active immunity. People are born with active immunity in which the body recognizes a foreign protein and begins producing antibodies to react with specific proteins or antigens. Serum sickness is a massive immune reaction against the injected antibodies that occur with passive immunity.

Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 3 Page and Header: 314, Box 18.2 Client Teaching: Pediatric Immunization 2. A parent is discussing their concern about agreeing to vaccinate their newborn especially with the MMR vaccine with the nursery nurse. What information concerning the review of evidence by the American Academy of Pediatrics should guide the nurse’s response? A) The MMR vaccine is not a major risk factor for the development of autism. B) Autism is a developmental disability caused by differences in the brain. C) It has been determined that the MMR vaccine is not responsible for autism. D) Autism is rare, and the cause is unknown.

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Ans: C

Feedback: The experts at the CDC and the American Academy of Pediatrics reviewed the evidence and have determined that the MMR vaccine is not responsible for children developing autism. Sharing the fact that autism is rare brain disorder with an unknown cause is not helpful in addressing the parent’s concern. Parents need facts regarding the true side effects of vaccines as well as reassurance about modern efforts to prevent and screen for these reactions.

Format: Multiple Selection Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 315, Vaccines 3. A toddler has been brought to the community clinic and will be administered the ProQuad vaccine. When educating the child’s parents about this vaccine, the nurse should explain what benefit(s)? Select all that apply. A) protection against mumps and rubella B) protection against smallpox and yellow fever C) protection against measles and varicella D) protection against hepatitis B E) protection against polio and rotavirus

Ans: A, C

Feedback: The ProQuad vaccine only confers immunity against measles, mumps, rubella, and varicella virus. It is not effective for the other viruses mentioned.

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Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 312, Introduction 4. The nurse notes that the client has an extensive list of allergies. Prior to administering the hepatitis A immune globulin, what action should the nurse take? A) Perform a hepatitis A antibody check. B) Monitor the client carefully and have emergency equipment available. C) Apply ice to the injection site to slow the absorption of the serum. D) Give the client a corticosteroid as prescribed before the injection to modulate reaction.

Ans: B

Feedback: If a client has known allergies, it is important to monitor the client carefully and have emergency equipment ready if needed after injection of proteins such as immune globulin. Severe allergic reactions, including anaphylaxis, could occur. Ice would slow absorption of the immune globulin, delaying the reaction and delivery of the immune globulin to the bloodstream where it can act on the hepatitis A virus. If a person had hepatitis A antibodies, the immune globulin would not be needed. The delay in getting that information could be problematic if the client had been exposed to hepatitis A. Corticosteroids can reduce immune response and so would be contraindicated.

Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Teaching/Learning Objective: 2 Page and Header: 322, Patient Teaching for S.D. 5. A nurse is providing client education to the parent of a child receiving their first immunization. The nurse should educate the parent that it is common for the child to exhibit what signs and symptoms afterward? A) vomiting and diarrhea for up to 24 hours B) temporary high fever and sweating C) lethargy, drowsiness, and irritability D) pain, redness, and swelling at site of injection

Ans: D

Feedback: Normal reactions to immunizations include pain, redness, and swelling at the site of the injection. Vomiting, diarrhea, high fever, sweating, lethargy, or drowsiness would not be expected and should be reported. The child could also be slightly irritable due to the pain at the injection site.

Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 313, Biologicals 6. A 69-year-old client asks the nurse about whether the pneumonia vaccine is necessary. The client’s health record reveals that the client received the vaccine at age 55. What should the nurse tell the client? A) “Depending on the original vaccine, you may not need it again.” B) “This vaccine is given every 15 years and you will be due next year.”

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C) “This vaccine is only repeated if the first dose was given before age 65. You should have another vaccine.” D) “This vaccine is no longer recommended because modern strains of pneumonia are not responding well to it.”

Ans: A

Feedback: The pneumococcal 13-valent conjugate vaccine is believed to offer lifetime protection. The vaccine is recommended for anyone at risk, especially those over age 65.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 313, Biologicals 7. The nurse is educating a couple about the recommended immunization plan for their infant. What should the nurse teach these new parents? A) Whenever possible, avoid having the child receive more than one vaccine at a time. B) Stop the immunizations after 2 years of age, provided the program has been adhered to up to that age. C) Keep a written record of the child’s immunizations. D) The child’s risk factors for autism will be assessed before any immunizations are given.

Ans: C

Feedback: The nurse should provide thorough client teaching, including measures to avoid adverse effects, warning signs of problems, the need to keep a written record of immunizations, to increase knowledge about drug therapy, and to increase compliance

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with the drug regimen. Immunization records are often requested when the child is being enrolled in school so it is important for the parents to maintain these records. The nurse would not teach the parents to avoid having the child receive more than one vaccine at a time or to stop the immunizations after the age of 2; both are acceptable practices. There is no demonstrated link between immunizations and autism.

Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 315, Vaccines 8. A parent brings the 18-month-old client into the clinic for a diphtheria, tetanus, and pertussis vaccine. The child has a runny nose, a fever of 102.4°F (39.1°C), and is coughing. What is the nurse’s appropriate action? A) Administer the vaccine but monitor the child afterward for an extended time period. B) Give an antipyretic and administer vaccine when temperature is within normal range. C) Administer a reduced dose of the vaccine today and the remainder when child is healthy. D) Hold the immunization until the child is free of allergic or coldlike symptoms.

Ans: D

Feedback: The nurse should not administer the immunization if the child exhibits signs of acute infection because the vaccine can cause mild infection and can exacerbate acute infections. The child should be free of infection for several days before the immunization is given. Treating the fever, extended monitoring, or smaller doses will not overcome this risk, and the only option is to hold the immunization until the child is healthy.

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Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 322, Immune Sera 9. What client would be most likely to benefit from the administration of an antitoxin? A) a 12-month-old client who is exhibiting signs of anaphylaxis after receiving a scheduled vaccination B) a 12-year-old client who has risk factors for human papillomavirus (HPV) C) a client who will soon be traveling to a location where yellow fever is endemic D) a client in distress who is showing signs and symptoms of botulism

Ans: D

Feedback: Botulism is an example of a health problem that can be treated with an antitoxin. HPV and yellow fever do not have a toxic etiology and cannot be treated by an antitoxin. Antitoxins are not used in the treatment of anaphylaxis.

Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 315, Vaccines 10. The infection control nurse is assessing the immunization status of many of the hospital’s current clients. For what client would vaccination most likely be contraindicated?

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A) a client who receives dialysis three times weekly for chronic renal failure B) a client with alcoholic liver disease C) a client who takes immunosuppressants postrenal transplant D) a client who is 82 years old and who has type 1 diabetes

Ans: C

Feedback: The use of vaccines is contraindicated in the presence of immune deficiency because the vaccine could cause disease and the body would not be able to respond as anticipated if in an immunodeficient state. Vaccines are not contraindicated in people with renal impairment or who have hepatic failure nor are they contraindicated in people over the age of 65.

Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 315, Vaccines 11. The clinic nurse is administering vaccines at well-baby checkups. Before administering a diphtheria, tetanus, and pertussis (DTP) vaccine, what assessment parameter should the nurse prioritize? A) temperature B) body mass index C) recent administration of acetaminophen D) vaccine history not up-to-date

Ans: A

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Feedback: Caution should be used whenever a vaccine is given to a child with a history of febrile convulsions or cerebral injury, or in any condition in which a potential fever would be dangerous. Caution also should be used in the presence of any acute infection, which would often be signaled by fever. BMI is not a major consideration, and recent use of acetaminophen is not problematic. If the recipient is behind schedule on vaccination, this should encourage the nurse to offer the vaccine.

Format: Multiple Selection Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 321, Educating a Parent About Vaccines 12. The nurse assigned to perform telephone triage for the clinic receives a call from a young parent whose 6-month-old baby received their third diphtheria–pertussis–tetanus immunization that morning. The parent reports the baby’s temperature is 99.8°F (37.7°C) axillary, the site of injection is “a little red,” and the baby is irritable. After checking the standing orders provided by the pediatrician, what teaching would the nurse provide this parent? Select all that apply. A) “These are common adverse effects reported after immunizations.” B) “Bring the baby back to the clinic for an examination.” C) “Apply a warm moist compress to the baby’s leg.” D) “Aspirin can be given to manage fever symptoms.” E) “Symptoms should subside within 2 to 3 days.”

Ans: A, C, E

Feedback: The signs reported by this parent are all common adverse effects following immunization that will subside within 2 to 3 days. In the meantime, the parent can make the baby more comfortable by administering a weight appropriate dosage of

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acetaminophen, applying warm compresses to the injection site, and providing a quiet environment. If the symptoms do not subside within 2 to 3 days, the baby should be seen for follow-up care. Aspirin should not be given due to risk of Reye’s syndrome.

Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 322, Measles, Mumps, and Rubella Vaccine 13. A parent has contacted the nurse and is concerned about media reports of a measles outbreak. The parent wants to confirm that their 9-month-old child has been immunized against measles. What is the best response by the nurse? A) If the parent has adhered to the recommended schedule, the child was immunized 3 months ago. B) The child was likely immunized prior to discharge postdelivery. C) The child should receive the vaccine promptly. D) Twelve months is the youngest age at which the child should be vaccinated.

Ans: D

Feedback: MMR is administered initially as a combined vaccine at 12 months.

Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process

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Objective: 3 Page and Header: 313, Biologicals 14. The nurse works with the client in a long-term care facility. What principle should guide the nurse’s administration of influenza vaccinations? A) Influenza vaccinations should be administered to all residents under the age of 80. B) Unless contraindicated, residents should receive influenza vaccinations annually. C) Residents should be offered an influenza booster every 5 years. D) New residents should receive a one-time dose of influenza vaccine.

Ans: B

Feedback: Older adults should be given the annual influenza vaccine unless directly contraindicated. This includes residents over the age of 80.

Format: Multiple Selection Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 315, Vaccines 15. Media reports in the community have focused on the risks of hepatitis B. The hepatitis B vaccine is recommended for what individuals? Select all that apply. A) adolescents over the age of 13 B) infants C) anyone with acute or chronic renal failure D) individuals aged 65 years or older E) individuals with a known risk of hepatitis B exposure Ans: B, E

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Feedback: Patients indicated to receive the vaccine are susceptible people and infants. Indications for receiving the vaccine do not include adolescents, people with renal disease, or all people over the age of 65.

Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 3 Page and Header: 313, Biologicals 16. A 82-year-old client is brought to the clinic by their adult child. The adult child asks how often their parent should receive the influenza vaccine. What would be the nurse’s appropriate response? A) “A decision about the influenza vaccine is made on the basis of your parent’s individual risk factors.” B) “Your parent needs the influenza vaccine every 10 years.” C) “Your parent should receive the vaccine once, with two booster injections, 6 months apart.” D) “Your parent needs the influenza vaccine once each year.”

Ans: D

Feedback: In general, all adults with chronic diseases are advised to be immunized yearly with an influenza vaccine and once with a pneumococcal pneumonia vaccine. Boosters are not required.

Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1, 5 Page and Header: 315, Vaccines 17. An employee of a long-term care facility has been administered the hepatitis B series prior to beginning employment. How should the employee’s therapeutic response to the vaccination be best assessed? A) Measure the employee’s serum antibody levels. B) Attempt to palpate the employee’s liver and spleen. C) Monitor the client’s bilirubin, AST, ALT, and albumin levels. D) Monitor the client for signs and symptoms of hepatitis B infection.

Ans: A

Feedback: Antibody titers (i.e., levels of the antibody in the serum) can be used to evaluate a client’s response to an immunization and to determine the need for a booster dose. This is a more direct assessment than assessing liver enzymes, signs and symptoms, or performing palpation.

Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 5 Page and Header: 314, Box 18.3 Focus on Safe Medication Administration 18. A client has presented to the clinic for an allergy shot. The client asks the nurse what immunoglobulin (Ig) is located in the body’s tissues and is thought to be responsible for allergic reactions. What is the nurse’s appropriate response? A) IgG is thought to be responsible for allergic reactions.

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B) IgA is thought to be responsible for allergic reactions. C) IgM is thought to be responsible for allergic reactions. D) IgE is thought to be responsible for allergic reactions.

Ans: D

Feedback: IgE is the immune globulin that is associated with allergic reactions. These antibodies react with mast cells, causing the release of histamine and other inflammatory chemicals when they have combined with the antigen. IgG, IgA, and IgM are not involved in allergic reactions.

Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 3 Page and Header: 315, Vaccines 19. The school nurse is addressing a parents’ group and is discussing an upcoming campaign of human papillomavirus (HPV) vaccination. What should the nurse teach this group of parents? A) HPV vaccination is based on a thorough health history of each child. B) HPV vaccination is recommended for all girls, aged 15 years and older. C) HPV vaccination is recommended for both boys and girls. D) HPV vaccination confers protection against a variety of sexually transmitted viruses. Ans: C

Feedback: HPV vaccination is recommended for males and females alike. It is not offered or withheld on the basis of health history, though high-risk individuals may be offered it at a younger age. Protection is exclusive to the human papillomavirus.

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Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 322, Immune Sera 20. A client is brought to the emergency department after being bitten by a snake. The nurse asks the client to carefully describe the snake that bit them. The nurse would ask this question for which reason? A) Antivenin is very specific with regard to the venoms it can treat. B) Antivenin can only respond to cells that have not been attacked by the venom. C) Antivenin only responds to a specific group of spiders or snakes. D) Antivenin has serious adverse effects that must be weighed carefully against potential benefits.

Ans: A

Feedback: The term antivenin is used to refer to immune sera that have antibodies to venom that might be injected through spider or snake bites. These drugs are used to provide early treatment following exposure to known antigens. They are very specific for antigens to which they can respond, so the identity of the animal must be confirmed. This is not because of the seriousness of adverse effects or the effects on certain cells. Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 315, Vaccines

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21. A healthy neonate will be discharged from the hospital 36 hours after birth. How should the nurse promote the neonate’s immune function? A) Administer first measles–mumps–rubella vaccination as prescribed. B) Administer pneumococcal vaccine as prescribed. C) Administer hepatitis B vaccination as prescribed. D) Administer the varicella vaccine as prescribed.

Ans: C

Feedback: The only vaccination normally administered at birth is for hepatitis B. Varicella, MMR, and pneumococcal vaccines are given later in life.

Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 322, Immune Sera 22. A client has presented to the clinic and is requesting the seasonal influenza vaccine. What aspect of the client’s health history may contraindicate the safe and effective use of this vaccine? A) The client is currently prescribed prednisone. B) The client takes a loop diuretic for the treatment of hypertension. C) The client is 76 years old. D) The client does not know their blood type, and it is not recorded in available health records.

Ans: A

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Feedback: The use of corticosteroids such as prednisone could alter the body’s desired response to a vaccine. A loop diuretic has no significant effect, and the client’s age is not a contraindication. It is unnecessary to know the client’s blood type.

Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 315, Vaccines 23. A 79-year-old client has been prescribed a single dose of influenza A vaccine 0.5 mL SC. What is the nurse’s priority action? A) Assess the client, confirm identity, and administer the vaccine. B) Document administration of the vaccine. C) Contact the provider to confirm the route. D) Educate the client about potential adverse effects.

Ans: C

Feedback: The influenza vaccine is given IM, not subcutaneously. The dose is appropriate, but the nurse would have to confirm the route before performing education or administering the vaccine.

Format: Multiple Selection Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 3, 5 Page and Header: 315, Vaccines 24. The nurse is preparing for a visit with an 8-week-old infant. What immunizations will the nurse prepare? Select all that apply. A) diphtheria and tetanus toxoids and acellular pertussis vaccine, adsorbed (DTaP) B) inactivated poliovirus vaccine (IPV) C) Haemophilus influenzae type b conjugated vaccine D) varicella E) meningococcal polysaccharide vaccine

Ans: A, B, C

Feedback: At 6 to 8 weeks (2 months) of age, the child will receive a DTaP, Hib, IPV, and PCV. Varicella vaccine is not given until the child is at least 1 year of age, and meningococcal polysaccharide vaccine is usually given at age 9 months unless the client is at high risk for development of the disease before that age.

Format: Multiple Selection Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1, 5 Page and Header: 315, Vaccines 25. The nurse provides client teaching to a client. The nurse explains the purpose of vaccines is to promote what? Select all that apply. A) active immunity B) passive immunity C) short-term immunity D) lifetime immunity E) activation of the immune system

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Ans: A, D, E

Feedback: The word vaccine comes from the Latin word for smallpox, vaccinia. Vaccines are immunizations containing weakened or altered protein antigens that stimulate the formation of antibodies against a specific disease. They are used to promote active immunity that will last for a lifetime, although some clients will require smaller booster doses to maintain immunity.

Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 315, Vaccines 26. The nurse is caring for a 30-year-old woman who presented to their gynecologist today to receive a human papillomavirus (HPV) vaccine (Gardasil), stating that they believe that they may have genital warts. What should the nurse teach this client? A) “This vaccine is only given to women between the ages of 9 and 26 years.” B) “The drug is only effective if administered before exposure to human papillomavirus (HPV).” C) “The drug cannot be administered to a woman who is sexually active.” D) “The drug cannot be administered until further Food and Drug Administration (FDA) testing has been completed.”

Ans: B

Feedback: This client is not a candidate for the human papillomavirus (HPV) vaccine (Gardasil) primarily because they have most likely already been exposed to HPV, and there would be no benefit to the injection. The human papillomavirus (HPV) vaccine is a

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vaccine that needs to be administered before exposure to be effective. Although the drug is normally given to women aged 9 to 26 years old, it could be given to an older person who has not become sexually active yet. Although sexual activity would not preclude administering the injection to a young girl who has had only one sexual partner, multiple partners increase the likelihood of exposure to HPV. The FDA continues to monitor testing related to the need for booster shots and the length of time the immunity remains active, as well as long-term adverse effects of the drug, but the drug is available to the public by prescription.

Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 319, Box 18.4 Vaccines and Biological Weapons 27. Which biological weapon is considered highly transmissible? A) botulism B) smallpox C) tularemia D) anthrax

Ans: B

Feedback: Smallpox is highly transmissible and has a 30% mortality rate in unvaccinated people. The remaining options require direct expose to the organism.

Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 319, Box 18.5 SARS-CoV-2 (COVID-19) Vaccine 28. What type of vaccine was the first to receive FDA approval for the prevention of COVID-19? A) immune globulin B) viral vector C) mRNA-based D) antivenin

Ans: C

Feedback: Since the emergence of SARS-CoV-2 (COVID-19) at the end of 2019, researchers have been developing vaccines to prevent transmission and illness from this virus. Research quickly evolved, and two mRNA-based vaccines were formally approved for use by the FDA. There was also a viral vector vaccine that was formally approved. This information eliminates the other options as being correct.

Format: Multiple Selection Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 313, Box 18.1 Focus on Drug Therapy across the Lifespan: Biologicals 29. Which client’s vaccination history indicates a need of updating? Select all that apply. A) a 15-year-old client diagnosed with asthma who has never had an influenza vaccination B) a 7-month-old client who has received three doses of HPV recombinant vaccine

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C) a 46-year-old carpenter who has never had a zoster vaccination D) a 30-year-old computer programmer whose last tetanus shot was 6 years ago E) a 20-year-old client diagnosed with cystic fibrosis who never received a pneumococcal vaccine

Ans: A, E

Feedback: Influenza vaccination requires a yearly update, and a pneumococcal vaccination is appropriate for adults older than 19 years of age who are immunocompromised or have specific chronic diseases. HPV recombinant vaccine is dosed at 0, 1, and 6 months, while a tetanus booster is suggested every 10 years and a zoster vaccination is recommended for those 50 years of age and older.

Format: Multiple Selection Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 319, Box 18.4 Vaccines and Biological Weapons 30. What situation(s) would prevent the administration of the anthrax vaccine to an adult? Select all that apply. A) latex allergy B) raxibacumab allergy C) pregnancy D) allergy to ciprofloxacin E) diagnosis of type 1 diabetes

Ans: A, C

Feedback: People who are pregnant and people with latex allergy should not be administered the anthrax vaccine. Ciprofloxacin and doxycycline are antibiotics that can

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be used to prevent anthrax. The monoclonal antibody, raxibacumab, is specific to the anthrax bacillus and is used for treatment postexposure, along with standard antibiotic therapy. Allergies to any of these drugs would not interfere with the administration of the anthrax vaccine. A diagnosis of type 1 diabetes is not a contraindication for this vaccine.

Format: Multiple Choice Chapter: 18 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 313, Box 18.1 Focus on Drug Therapy across the Lifespan: Biologicals 31. While traveling, an older adult realize that the area they are visiting is currently experiencing an increased risk for a communicable disease? What resource should the individual use to best determine the most effective prophylactic treatment? A) the state’s Health Department B) Centers for Disease Control and Prevention C) the local Health Department D) the local hospital

Ans: B

Feedback: If an older client is traveling to an area where a particular disease is endemic and the risk of exposure is great, the Centers for Disease Control and Prevention (http://www.cdc.gov) should be contacted to determine whether the appropriate vaccine is acceptable for use in the older client.

Test Generator Questions, Chapter 19, Introduction to Nerves and the Nervous System

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Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 332, Physiology of the Nervous System 1. Information is being carried into a client’s neuron from other neurons. What component of the neurologic system will perform this function? A) axon B) dendrite C) nucleus D) soma

Ans: B

Feedback: Dendrites carry information to the nerve and axons; they also carry information from a nerve to be transmitted to effector cells, which are found in muscles, glands, or another nerve. Soma refers to the cell body. The nucleus is the central part of a cell, which is responsible for the cell’s growth, reproduction, and metabolism.

Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 332, Physiology of the Nervous System 2. A client’s neuron is stimulated and depolarization of the nerve has occurred. The nurse should anticipate what subsequent action?

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A) Calcium rushes into the cell. B) Sodium rushes into the cell. C) Potassium rushes into the cell. D) Sodium and potassium are actively pumped out to the cell.

Ans: B

Feedback: When depolarization occurs, sodium rushes into the cell. During repolarization, potassium is pumped out of the cell and the resting membrane potential is reestablished. Calcium ions decrease the cell membranes’ permeability to sodium and increase the threshold needed to depolarize the cell.

Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 332, Physiology of the Nervous System 3. A client has experienced a seizure. A deficiency in what neurotransmitter may have caused the client’s seizure activity? A) acetylcholine B) dopamine C) gamma-aminobutyric acid (GABA) D) serotonin

Ans: C

Feedback: GABA is found in the brain and inhibits nerve activity. It is important in preventing overexcitability or stimulation such as seizure activity. Acetylcholine communicates between nerves and muscles. Dopamine is involved in the coordination of

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impulses and responses, both motor and intellectual. Serotonin is found in the limbic system and is important in arousal and sleep as well as in preventing depression and promoting motivation.

Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 336, Central Nervous System 4. The nurse is caring for a client who has an injured hindbrain. When assessing the client, the nurse should anticipate abnormal findings in what domain? A) arousal and awareness B) basic vital functions C) coordination and motor activity D) learning and motivation

Ans: B

Feedback: The hindbrain contains centers that control basic vital functions (e.g., blood pressure, respirations, vomiting). The reticular activating system in the medulla controls arousal and awareness. Learning and motivation occur in the cerebral cortex. Coordination and motor activity are controlled through the cerebellum and basal ganglia.

Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Difficult

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Integrated Process: Nursing Process Objective: 4 Page and Header: 336, Central Nervous System 5. A client has experienced a stroke affecting the right side of their brain. What assessment finding is most likely attributable to this health problem? A) inability to recall the name of a best friend B) inability to state their telephone number C) inability to distinguish a spoon from a fork D) inability to recall how to apply makeup

Ans: C

Feedback: The right side of the brain is the artistic side and is concerned with forms and shapes. This client could have difficulty distinguishing the roundness of the spoon with the straight line of the top of the fork. The left side of the brain is more analytical and is concerned with names, numbers, and processes.

Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 336, Central Nervous System 6. The nurse is caring for a client with meningitis who is not responding to the prescribed antibiotic and whose condition continues to deteriorate. The nurse should provide which rationale to explain why the client is not responding? A) The meninges do not have a blood supply. B) The blood–brain barrier prevents the antibiotics from crossing into the brain. C) The circle of Willis redirects the antibiotic elsewhere. D) The pressure in the hindbrain prevents antibiotic entry into the skull.

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Ans: B

Feedback: The blood–brain barrier works to keep large molecules out of the brain and away from the nerves. Most antibiotics are protein bound and cannot pass through the blood–brain barrier. When the infection becomes severe, the blood–brain barrier will stop being effective and the antibiotics can pass into the brain. The brain has a unique blood supply to protect the neurons from lack of oxygen and glucose. After the blood– brain barrier allows the antibiotic to pass through, the circle of Willis distributes the blood to the areas of need. If someone has an occluded carotid artery, which could build pressure up in the area, the circle of Willis can redirect the blood supply and provide a full blood supply to the affected areas.

Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Page and Header: 336, Central Nervous System 7. A nurse is caring for a client who is having adverse effects from long-term antipsychotic treatment. The client is experiencing tremors, shuffles when walking, and is having difficulty sitting up in bed. What disruption to the neurologic system should the nurse suspect? A) an interference with the extrapyramidal system B) a faulty engram C) an alteration in the reticular activating system D) an interference with a neurotransmitter

Ans: A

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Feedback: The extrapyramidal system coordinates unconscious motor activity that regulates control of position and posture. An engram is a reverberating circuit of action potentials that becomes a long-term, permanent memory in the presence of the proper neurotransmitters and hormones. The reticular activating system, which is located in the hindbrain, controls arousal and awareness of stimuli and contains the sleep center. A neurotransmitter is a chemical that stimulates postsynaptic cells either by exciting or by inhibiting them.

Format: Multiple Choice Chapter: 19 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 336, Central Nervous System 8. A nurse is working on a surgical unit and has several clients who require preoperative teaching. Which client demonstrates behavior indicating this is an appropriate time to begin teaching? A) A client who is wide eyed and extremely frightened about being “put to sleep.” B) A client who appears to be unconcerned about what is happening and wants to watch their favorite TV show. C) A client who is clearing their throat several times while asking the nurse questions during conversation and who appears to be slightly stressed. D) A client who is getting up and down from the bed, talking very fast, and appears to be extremely anxious.

Ans: C

Feedback: Several substances appear to affect learning. Antidiuretic hormone (ADH), which is released during reactions to stress, is one such substance. Although too much stress prevents learning, feeling slightly stressed may increase a person’s ability to

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learn. A client who is a little nervous about upcoming surgery, for example, seems to display a better mastery of facts about the surgery and postoperative procedures than a client who is very stressed and scared or one who appears to show no interest or concern.

Format: Multiple Selection Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 336, Central Nervous System 9. The nurse is caring for a client whose unpredictable emotions are due to an infarct in the limbic system. What hormone(s) are considered relevant to this impairment? Select all that apply. A) epinephrine B) serotonin C) gamma-aminobutyric acid D) norepinephrine E) dopamine F) acetylcholine

Ans: A, B, D

Feedback: The limbic system contains high levels of epinephrine, norepinephrine, and serotonin. Dopamine, acetylcholine, and gamma-aminobutyric acid are found in the brain but not primarily in the limbic system.

Format: Multiple Choice Chapter: 19

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Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 336, Central Nervous System 10. A client is diagnosed with pheochromocytoma, which causes hypertension due to excessive hormone release from the adrenal medulla. This client’s symptoms are due to disruptions in the level of what hormone? A) ephedrine B) norepinephrine C) dopamine D) acetylcholine

Ans: B

Feedback: Norepinephrine and epinephrine are catecholamines, which are released by nerves in the sympathetic branch of the autonomic nervous system and are classified as hormones when they are released from cells in the adrenal medulla. The other listed options are not released from the adrenal medulla.

Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 336, Central Nervous System 11. A client sustained a closed-head injury 4 hours ago and now presents to the emergency department with difficulty breathing. The nurse should suspect damage to what part of the brain?

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A) thalamus B) cerebrum C) pituitary D) medulla oblongata

Ans: D

Feedback: The hindbrain, which runs from the top of the spinal cord into the midbrain, is the most primitive area of the brain and contains the brainstem, where the pons and medulla oblongata are located. This area of the brain controls basic vital functions such as the respiratory centers, which control breathing; the cardiovascular centers, which regulate blood pressure; the chemoreceptor trigger zone and emetic zone, which control vomiting; the swallowing center, which coordinates the complex swallowing reflex; and the reticular activating system (RAS), which controls arousal and awareness of stimuli and contains the sleep center. The midbrain contains the thalamus and hypothalamus and the limbic system that transfer sensations into the cerebrum and control temperature. The pituitary gland is known as the master gland, controlling other glands with hormones secreted here.

Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 336, Central Nervous System 12. What client is most likely to have sustained damage to their limbic system? A) a client who requires mechanical ventilation following a head injury B) a client whose gait is unbalanced and who frequently falls C) a client whose moods are described as “volatile” and “unpredictable” D) a client whose sense of smell no longer exists

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Ans: C

Feedback: The limbic system is responsible for the expression of emotions. The limbic system does not regulate balance, special senses, or respiration.

Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 332, Physiology of the Nervous System 13. The nurse is caring for a client who is believed to be greatly deficient in serotonin. What assessment is a nursing priority? A) vital signs B) assessment of falls risk C) assessment for suicide risk D) deep tendon reflexes

Ans: C

Feedback: Serotonin prevents depression. Restoration of serotonin levels is a cornerstone of depression therapy, and low levels could constitute a suicide risk. This deficiency would not cause disruptions in balance, vital signs, or reflexes.

Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 332, Physiology of the Nervous System 14. A client’s nerve transmission has reached the end of an axon. What event will take place next? A) An enzyme will be released. B) An electrical impulse will stimulate a dendrite. C) The synaptic gap will close. D) A neurotransmitter will be released.

Ans: D

Feedback: The nerve axon, called the presynaptic nerve, releases a chemical called a neurotransmitter into the synaptic cleft; the neurotransmitter reacts with a very specific receptor site on the postsynaptic cell to cause a reaction that increases synaptic transmission. Communication between nerves occurs through the action of neurotransmitters, not enzymes or electrical activity. Synaptic gaps never physically close.

Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 332, Physiology of the Nervous System 15. A client’s muscle weakness has been found to result from a lack of neurotransmitter communication between nerves and muscles. What neurotransmitter is most likely deficient? A) acetylcholine

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B) dopamine C) gamma-aminobutyric acid (GABA) D) serotonin

Ans: A

Feedback: Acetylcholine communicates between nerves and muscles. Dopamine is involved in the coordination of impulses and responses, both motor and intellectual. GABA inhibits nerve activity. Serotonin is important in arousal and sleep.

Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 332, Physiology of the Nervous System 16. What is the major inhibitory neurotransmitter in the central nervous system (CNS)? A) acetylcholine B) dopamine C) gamma-aminobutyric acid (GABA) D) serotonin

Ans: C

Feedback: GABA, which is found in the brain, inhibits nerve activity and is important in preventing overexcitability or stimulation such as seizure activity. Acetylcholine, which communicates between nerves and muscles, is also important as the preganglionic neurotransmitter throughout the autonomic nervous system and as the postganglionic neurotransmitter in the parasympathetic nervous system and in several pathways in the brain. Dopamine is involved in the coordination of impulses and responses, both motor

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and intellectual. Acetylcholine, dopamine, and serotonin are not the major inhibitory neurotransmitter in the CNS. Serotonin is important in arousal and sleep.

Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 336, Central Nervous System 17. A client has suffered damage to the thalamus as a result of a stroke. The client would exhibit deficits with what neurological function? A) relaying motor impulses from the cortex to the spinal cord B) coordinating voluntary movement C) conveying information about sensations to the cerebrum D) regulating emotions

Ans: C

Feedback: The thalamus sends direct information into the cerebrum to transfer sensations, such as cold, heat, pain, touch, and muscle sense. Motor fibers from the cortex cross to the other side of the spinal cord before emerging to interact with peripheral effectors. In this way, motor stimuli coming from the right side of the brain affect motor activity on the left side of the body. The thalamus does not regulate emotions or coordinate movement.

Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand

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Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 332, Physiology of the Nervous System 18. A client’s nerves have been stimulated and the signal has reached the axon. How will communication continue? A) Through the production of an electrical signal. B) By the release of a neurotransmitter. C) By physically stimulating the nerve on the other side of the synapse. D) The nerve signal will cease at this point.

Ans: B

Feedback: The transmission of information between two nerves or between a nerve and a gland or muscle is chemical, achieved by the release of a neurotransmitter. Communication is not electrical or physical, and communication does not necessarily cease at the axon.

Format: Multiple Selection Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 336, Central Nervous System 19. A nurse is reviewing the function of the forebrain before assessing a client on the neurological unit. The nurse should identify what function(s) of this part of the brain? Select all that apply. A) coordination of speech and communication B) learning C) housing of the extrapyramidal motor system

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D) housing the cranial nerves E) containing the swallowing center

Ans: A, B, C

Feedback: The forebrain is made up of two cerebral hemispheres joined together by the corpus callosum. The two hemispheres contain the sensory and motor neurons. It also contains areas that coordinate speech and communication and is thought to be where learning takes place. Cranial nerves emerge from the hindbrain, which is where the swallowing center is located as well.

Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 336, Central Nervous System; 336, Key Points 20. The nurse is describing the structure and function of the two hemispheres of the brain to a recent graduate. What regulatory function should the nurse describe? A) regulation of the electrical conduction system of the brain B) regulation of the afferent conduction system C) regulation of the efferent conduction system D) regulation of communication between sensory and motor neurons

Ans: D

Feedback: The cerebral cortex consists of two hemispheres, which regulate the communication between sensory and motor neurons and are the sites of thinking and learning. The regulatory functions of the hemispheres do not focus electrical, afferent, or efferent conduction.

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Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 336, Central Nervous System 21. A client’s dysphagia has been attributed to damage to the client’s swallowing center. This client has dysfunction in what part of the brain? A) hindbrain B) right hemisphere C) forebrain D) left hemisphere

Ans: A

Feedback: The pons and medulla oblongata are in the hindbrain and control basic, vital functions, such as the respiratory centers, which control breathing; the cardiovascular centers, which regulate blood pressure; the chemoreceptor trigger zone and emetic zone, which control vomiting; and the swallowing center, which coordinates the complex swallowing reflex.

Format: Multiple Selection Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 2

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Page and Header: 332, Physiology of the Nervous System 22. What hormone(s) provide required energy to the nerves? Select all that apply. A) dopamine B) oxygen C) potassium D) acetylcholine E) serotonin F) glucose

Ans: B, F

Feedback: Nerves require energy (i.e., oxygen and glucose) and the correct balance of the electrolytes sodium and potassium to maintain normal action potentials and transmit information into and out of the nervous system. Energy required by the nerves is not provided by dopamine, potassium, acetylcholine, or serotonin.

Ans: C

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Feedback: The forebrain is made up of two cerebral hemispheres that contain areas that coordinate speech and communication and are thought to be the area where learning takes place. The forebrain does not coordinate sensation or movement or communicate between the sensory and motor systems.

Ans: A

Feedback: Oxytocin and mild stress act to increase actual learning. Childbirth is the only time that oxytocin levels increase, and this phenomenon is not clearly understood. Extreme anxiety, excitement, and prolonged sleep do not increase learning.

Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 4 Page and Header: 336, Central Nervous System 25. The sensory nerves enter the brain and react with related nerves to cause a reaction. What mediates this reaction? A) muscles or glands B) the limbic system C) the cerebral cortex D) neurotransmitters

Ans: A

Feedback: The sensory nerves that enter the brain react with related motor nerves to cause a reaction mediated by muscles or glands. The motor impulses that leave the cortex are further regulated or coordinated by the pyramidal system, which coordinates voluntary movement, and the extrapyramidal system, which coordinates unconscious motor activity that regulates control of position and posture. Therefore, the other options are incorrect.

Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 332, Physiology of the Nervous System 26. A client is diagnosed with a neurologic disorder that affects the structure and function of the myelin sheath and Schwann cells. What effect will this client likely experience? A) slower than normal nerve conduction B) personality changes

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C) chronic pain D) lack of coordination

Ans: A

Feedback: Myelinated nerves have Schwann cells, which speed up nerve conduction. Their absence does not cause personality changes, pain, or lack of coordination.

Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 332, Physiology of the Nervous System 27. A client who nearly drowned is brought to the emergency department. The paramedics tell the nurse that the client was anoxic for approximately 5 minutes. Because of this anoxia, what might happen to the nerve cells? A) The nerves may repolarize too quickly. B) The nerves might not be able to depolarize. C) The nerves might not be able to maintain the sodium–potassium pump. D) The nerves may release inappropriate neurotransmitters.

Ans: C

Feedback: If a person has anoxia or hypoglycemia, the nerves might not be able to maintain the sodium–potassium pump, and with continued lack of oxygen and/or glucose, the nerve cell will die. It will not repolarize too quickly, be unable to depolarize, or release inappropriate neurotransmitters. Format: Multiple Choice Chapter: 19

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Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 332, Physiology of the Nervous System 28. What is the purpose of the myelin sheath? A) protects the nerve from damage B) speeds electrical conduction C) produces Schwann cells D) secretes neurotransmitters

Ans: B

Feedback: Long nerves are myelinated: they have a myelin sheath that speeds electrical conduction and protects the nerves from the fatigue that results from frequent formation of action potentials, not from damage. Although myelin sheaths have Schwann cells, they do not produce these cells and the myelin sheath does not secrete neurotransmitters.

Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 332, Physiology of the Nervous System 29. The client is diagnosed with myasthenia gravis, a condition in which antibodies block, alter, or destroy the receptors for acetylcholine. What symptom would the nurse expect this client to display? A) muscle dysfunction

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B) seizures C) depression D) coma

Ans: A

Feedback: Acetylcholine communicates between nerves and muscles so inability of this neurotransmitter to function properly, whether blocking, altering, or destroying the receptors, would result in muscle dysfunction but not coma. Inadequate gammaaminobutyric acid would result in seizures. Serotonin is important in preventing depression.

Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 336, Central Nervous System 30. The nurse is caring for a client diagnosed with a malignant brain tumor. The client asks the nurse why the tumor is being treated with radiation instead of chemotherapy. The nurse’s explanation involves what important information? A) “Medications have difficulty crossing the blood–brain barrier.” B) “Neurons in the brain are easily damaged by chemotherapy.” C) “Tumors arising from nervous tissue are not impacted by chemotherapy.” D) “Chemotherapy reduces nerve transmission and cannot be used.” Ans: A

Feedback: The blood–brain barrier is a functioning boundary that plays a defensive role by keeping toxins, proteins, and other large structures out of the brain and preventing their contact with the sensitive and fragile neurons. As a result, medications like

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chemotherapy can have difficulty crossing this barrier to reach the tumor. The other answers are neither true nor the correct option.

Format: Multiple Choice Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 336, Central Nervous System 31. The nurse is caring for a client whose recent ultrasound of the carotids diagnosed a 90% occlusion of the right carotid artery and a 92% occlusion of the left carotid artery. The client asks the nurse, “If one of these arteries becomes completely occluded will I have a stroke?” What is the nurse’s best response? A) “A common vessel receiving all blood to the head called the circle of Willis will distribute blood from other arteries to the brain as needed.” B) “A stroke is caused by lack of blood supply to a part of the brain so if your right carotid artery becomes blocked, you’ll have a stroke on the right side of your brain.” C) “It is hard to predict exactly what will happen, so you’ll have to wait until your provider sees you because only the provider can answer that question.” D) “With only 10% of the blood needed getting through your right artery and 8% through your left artery, you could have a stroke now.”

Ans: A Feedback: All the arteries that supply blood to the head deliver blood to a common vessel at the bottom of the brain called the circle of Willis, which distributes the blood to the brain when it is needed. The role of the circle of Willis becomes apparent when someone has an occluded carotid artery. Although the passage of blood through one of the carotid arteries may be negligible, the areas of the brain on that side will still have a full blood supply because of the blood sent to those areas through the circle of Willis. All other options are incorrect.

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Ans: A

Feedback: Stimulation of the limbic system, which appears to be responsible for the expression of emotions, may lead to anger, pleasure, motivation, and stress. The forebrain is where thinking and coordination of sensory and motor activity occur. The hindbrain controls vital functions and arousal. The cerebellum controls motor functions that regulate balance. Format: Multiple Selection Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1

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Page and Header: 340, Summary 33. What component is vital to the regeneration of a nerve? Select all that apply. A) soma B) dendrite C) axon hillock D) axon E) ganglia

Ans: A, C

Feedback: Although nerves do not reproduce, they can regenerate injured parts if the soma and axon hillock remain intact. It is currently thought that neurons are unable to reproduce; so, if nerves are destroyed, they are lost. If dendrites and axons are lost, nerves regenerate those structures; however, for this regeneration to occur, the soma and the axon hillock must remain intact. A ganglia is a group of nerve bodies.

Format: Multiple Selection Chapter: 19 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 340, Summary 34. What component(s) serves to protect the brain from injury? Select all that apply. A) bony structure B) a secondary nerve network C) the circle of Willis D) specialized muscular system E) meninges

Ans: A, C, E

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Feedback: The CNS consists of the brain and spinal cord, which are protected by bone and meninges. To ensure blood flow to the brain if a vessel should become damaged, the brain also has a protective blood supply moderated by the circle of Willis. There is no secondary nerve network or specialized muscular system for the purpose of protecting the brain.

Test Generator Questions, Chapter 20, Anxiolytic and Hypnotic Agents Format: Multiple Choice Chapter: 20 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 343, States Affected by Anxiolytic and Hypnotic Drugs 1. What assessment finding best confirms that a client is in hypnosis? A) The client is sedated and does not sense or react to incoming stimuli. B) The client appears to be in a stated of tranquility and is open to suggestions from others. C) The client is uncharacteristically disoriented to person, place, or time. D) The client’s conversation is confused or unintelligible.

Ans: A

Feedback: Hypnosis is an extreme state of sedation in which the person no longer senses or reacts to incoming stimuli. A state of tranquility is produced through minor tranquilizers by decreasing anxiety. Sedation is the loss of awareness and reaction to environmental stimuli, which may lead to drowsiness. The state of suggestibility often

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seen in television programs is not an appropriate definition of hypnosis. Hypnosis is not synonymous with disorientation or confusion.

Format: Multiple Choice Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3 Page and Header: 343, Anxiolytic and Hypnotic Agents 2. A nurse is caring for a 4-year-old child who is receiving a barbiturate. What assessment should the nurse prioritize? A) cardiac monitoring B) assessment of deep tendon reflexes C) monitoring for agitation or restlessness D) hydration status

Ans: C

Feedback: The barbiturates, being older drugs, have established pediatric dosages. These drugs must be used with caution because of the often unexpected responses. Children must be monitored very closely for central nervous system (CNS) depression and excitability. Cardiac effects are less common, and hydration status is not normally affected. Deep tendon reflexes would only be affected in cases of extreme CNS depression.

Format: Multiple Choice Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze

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Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 3 Page and Header: 344, Benzodiazepines Used as Anxiolytic–Hypnotics 3. The nurse has provided health education related to the use of alprazolam with a 78year-old client. What statement best suggests that the client has an accurate understanding of the drug? A) “As soon as I stop having panic attacks, I can stop taking the drug.” B) “This drug will calm me down at around half an hour after I take it.” C) “I should expect one dose to keep me calm for about 12 hours.” D) “I am taking a slightly increased dose because of my age.”

Ans: B

Feedback: The onset of alprazolam is about 30 minutes. The drug must be tapered after long-term use, and the duration is approximately 4 to 6 hours. Older adult clients usually have a reduced dosage.

Format: Multiple Choice Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 348, Assessment: History and Examination 4. A nurse is about to administer a parenteral benzodiazepine to a client in the hospital before the performance of an invasive diagnostic procedure. What action should the nurse prioritize before administration of the drug? A) Auscultate the client’s lungs and set up pulse oximetry monitoring. B) Close the blinds and ensure appropriate room temperature for the client. C) Help the client out of bed to the bathroom and encourage the client to void.

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D) Ask all visitors to leave the room and remain in the waiting area.

Ans: C Feedback: The priority action would be to help the client up to void. After the medication is administered, the client should not get out of bed because of possible injury due to drowsiness. Safety should always be the priority concern. Respiratory assessment is not a priority, since respiratory depression does not normally occur. Creating a calm environment and asking visitors to leave may be necessary for the diagnostic procedure, but these actions do not have to precede benzodiazepine administration.

Format: Multiple Choice Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 352, Prototype Summary: Phenobarbital 5. The nurse is caring for an adult client who experienced a seizure 30 minutes before presenting into the emergency room, where the client begins to have another. What barbiturate would achieve the fastest therapeutic effect if administered intravenously? A) pentobarbital B) butabarbital C) phenobarbital D) secobarbital

Ans: C

Feedback: Phenobarbital’s onset is immediate if given IV. None of the other options react that quickly.

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Format: Multiple Choice Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 353, Other Anxiolytic and Hypnotic Drugs 6. Buspirone has been prescribed for a client diagnosed with anxiety. When providing health education, the nurse should describe what benefit of this medication over other anxiolytics? A) decreased risk of hepatic injury B) less central nervous system depression C) rapid onset and short duration D) sublingual administration

Ans: B

Feedback: Buspirone is a newer anxiolytic drug that does not cause sedation or muscle relaxation. It is preferred when the client needs to be alert such as when driving or working. Buspirone does not have a reduced risk of hepatic injury relative to other anxiolytics, nor does it have a faster onset and shorter duration. It is administered orally, not sublingually.

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Page and Header: 344, Benzodiazepines Used as Anxiolytic–Hypnotics 7. The nurse is caring for a resident in a long-term care facility with a history of an anxiety disorder. The client is receiving oral lorazepam 2 mg t.i.d. What assessment should the nurse prioritize? A) suicidal ideation B) level of consciousness C) sleep quality D) mucous membrane integrity

Ans: B

Feedback: Use benzodiazepines with caution in older adults or debilitated clients because of the possibility of unpredictable reactions and in cases of renal or hepatic dysfunction, which may alter the metabolism and excretion of these drugs, resulting in direct toxicity. As a result, they may develop high serum levels of these drugs, with increased sedation and an increased incidence of adverse effects. Nurses should assess all clients for suicidal ideation, but there is no particular reason why this client’s risk would be especially high. The nurse should assess the client’s sleep quality, but this does not affect the client’s safety level, like decreased level of consciousness. There is no particular reason for assessing the client’s mucous membranes.

Format: Multiple Choice Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 353, Other Anxiolytic and Hypnotic Drugs 8. An older adult client has been taking zolpidem as a sleep aid for the past 2 months. On admission to the assisted living facility, it is determined that the drug is no longer needed. What guideline should be included in the nurse’s care?

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A) The client has a risk of hallucinations when the dosage is adjusted. B) The drug needs to be withdrawn gradually. C) There is a risk of excessive sedation when the drug is discontinued. D) Sundowning is common with withdrawal from this drug.

Ans: B

Feedback: It is important for the nurse to understand that zolpidem must be withdrawn gradually over a 2-week period after prolonged use. Hallucinations and sundowning are not common with withdrawal of the drug. Agitation and insomnia would be risks, not sedation.

Format: Multiple Choice Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 344, Benzodiazepines Used as Anxiolytic–Hypnotics 9. Which client should the nurse expect to receive a lower-than-usual dose of benzodiazepines? A) a client whose anxiety is due to pain caused by gallstones B) a client with alcoholic liver disease C) a client who has irritable bowel syndrome D) a client who is 6 months postgastrectomy

Ans: B Feedback: The benzodiazepines are metabolized extensively in the liver. Clients with liver disease must receive a smaller dose and be monitored closely. Gastrointestinal and biliary health problems would not necessitate a lower dose.

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Format: Multiple Choice Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 353, Other Anxiolytic and Hypnotic Drugs 10. When compared with benzodiazepines, buspirone stands out as unique among antianxiety drugs because of what therapeutic advantage? A) increases the central nervous system (CNS) depression of alcohol and other drugs B) lacks muscle relaxant and sedative effects C) no risk of psychological dependence D) over-the-counter (OTC) availability

Ans: B

Feedback: Buspirone, a newer antianxiety agent, has no sedative, anticonvulsant, or muscle-relaxant properties, and its mechanism of action is unknown. However, it reduces the signs and symptoms of anxiety without many of the central nervous system effects and severe adverse effects associated with other anxiolytic drugs. Most of the antianxiety drugs are rapidly absorbed from the GI tract, metabolized in the liver, have a significant drug–drug interaction with alcohol and other drugs, and can result in psychological dependence. Buspirone is not available over the counter.

Format: Multiple Choice Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process

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Objective: 5 Page and Header: 348, Nursing Considerations for Patients Receiving Benzodiazepines 11. The nurse is caring for a client in an intensive care unit receiving IV lorazepam to reduce anxiety related to mechanical ventilation. While infusing the medication, the nurse notes a decrease in blood pressure and bradycardia. What is the nurse’s best action? A) Discontinue drug administration. B) Give the IV drug more slowly. C) Administer a normal saline bolus as prescribed. D) Document the reaction to the drug.

Ans: B

Feedback: The nurse’s priority action is to slow the rate of injection because rapid injection of benzodiazepines can result in hypotension and bradycardia and can lead to cardiac arrest. It is likely, however, that the drug can continue to be given at a lower rate. A bolus has no therapeutic effect. The nurse should document the client’s status, but slowing administration is a priority.

Format: Multiple Selection Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 344, Benzodiazepines Used as Anxiolytic–Hypnotics 12. Which of the client’s statement(s) should the nurse attribute to benzodiazepine withdrawal syndrome? Select all that apply. A) “I feel like my vision has been blurry the last few days.” B) “I feel dizzy from time to time, even when I’m lying still.” C) “I almost feel like I have a touch of the flu.”

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D) “Sometimes I can feel my heart skip a beat.” E) “I’ve completely lost my appetite the last little while.”

Ans: B, C

Feedback: Abrupt cessation of benzodiazepines may lead to a withdrawal syndrome characterized by nausea, headache, vertigo (dizziness), malaise (flulike symptoms), and nightmares. The nurse would not categorize palpitations, anorexia, or visual disturbances as signs of benzodiazepine withdrawal.

Format: Multiple Choice Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 344, Benzodiazepines Used as Anxiolytic–Hypnotics 13. An older adult client is brought to the emergency department by family members. The family states that the client has been uncharacteristically agitated and restless. The nurse reviews the client’s current medication regimen and suspects the client was recently prescribed what medication? A) lorazepam B) metoprolol C) cephalexin D) acetaminophen

Ans: A

Feedback: The adverse effects of benzodiazepines are associated with the impact of these drugs on the central and peripheral nervous systems. Nervous system effects include sedation, drowsiness, depression, lethargy, blurred vision, “sleep driving” and

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other complex behaviors, headaches, apathy, light-headedness, amnesia, and confusion. In addition, mild paradoxical excitatory reactions may occur during the first 2 weeks of therapy. Paradoxical reactions are an unintended, paradoxical response to a medication. In the case of benzodiazepines, it can result in excessive movements, agitation, talkativeness, impulsivity, irritability, and/or excitement (the opposite of a benzodiazepine’s intended effect). Neither antibiotics, beta-blockers, nor acetaminophen are associated with these paradoxical reactions.

Format: Multiple Choice Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 348, Nursing Considerations for Patients Receiving Benzodiazepines 14. The nurse is caring for a client who experiences anxiety and insomnia and is prescribed lorazepam. When developing the plan of care, what would be an appropriate nursing conclusion related to potential adverse effects of the drug? A) ineffective tissue perfusion related to vasoconstriction B) fear related to rebound effects following therapy C) risk for injury related to central nervous system (CNS) effects D) chronic confusion related to decreased arousal

Ans: C

Feedback: The most appropriate nursing conclusion related to adverse effects of the drug is risk for injury related to CNS effects because benzodiazepines can have many CNS adverse effects. There is no plausible risk of ineffective tissue perfusion or fear. CNS effects may have temporary effect of cognition, but this would not become chronic.

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Format: Multiple Choice Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 348, Nursing Considerations for Patients Receiving Benzodiazepines 15. The home care nurse is following up with a client who has been discharged from the hospital with a prescription for diazepam. On the initial visit what is the nurse’s priority related to this medication? A) teaching about herbal therapies that may be a safe and effective alternative B) ensuring that the client knows how to contact the provider if needed C) teaching the importance of taking medications for insomnia only occasionally D) warning signs that may indicate serious adverse effects

Ans: D

Feedback: The home care nurse should provide thorough client teaching, with a priority teaching point being the warning signs the client may experience that indicate a serious adverse effect. Although this may have been discussed by the discharging nurse in the hospital, this is essential information for the client to thoroughly understand. The client should have received the provider’s contact information when leaving the hospital, but the home care nurse may need to review this, even though it is not the priority teaching point. It is important to take hypnotics as ordered, and no more than necessary, but education about adverse effects is a priority.

Format: Multiple Choice Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 1 Page and Header: 343, States Affected by Anxiolytic and Hypnotic Drugs 16. The nurse is teaching a client who has been prescribed a hypnotic drug about the mechanism of action. The nurse should make reference to what physiological system? A) limbic system B) sympathetic nervous system C) reticular activating system D) renin–angiotensin–aldosterone system (RAAS)

Ans: C

Feedback: Hypnotics are used to help people fall asleep by causing sedation. Drugs that are effective hypnotics act on the reticular activating system and block the brain’s response to incoming stimuli. The sympathetic nervous system, limbic system, and RAAS are not involved.

Format: Multiple Choice Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 344, Benzodiazepines Used as Anxiolytic–Hypnotics 17. A client presents at the emergency department with respiratory depression and excessive sedation. The family tells the nurse that the client has been taking medication throughout the evening and gives the nurse an almost empty bottle of benzodiazepines. The nurse addresses potential factors that could exacerbate the effects of the benzodiazepines with which assessment question? A) “Is the client currently taking any blood pressure medications?” B) “Does the client have any history of kidney disease?”

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C) “Are there any allergies that you know about?” D) “Has the client had any alcohol to drink?”

Ans: D

Feedback: Alcohol exacerbates the toxic effects of benzodiazepines. Blood pressure medications, kidney disease, and allergies should all be assessed for, but none is likely to directly increase the effects of the overdose.

Format: Multiple Choice Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 350, Barbiturates Used as Anxiolytic–Hypnotics 18. A client is experiencing a seizure and the provider prescribes phenobarbital 6 mg IV STAT. What is the nurse’s best action? A) Obtain new IV tubing. B) Administer a normal saline bolus prior to phenobarbital, as prescribed. C) Question the provider about the order. D) Establish central IV access.

Ans: C

Feedback: Usual doses for phenobarbital are 30–120 mg/d PO, IM, or IV. The ordered dose is far below this range so contacting the provider is a priority over the other listed actions.

Format: Multiple Choice

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Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 2, 3 Page and Header: 344, Benzodiazepines Used as Anxiolytic–Hypnotics 19. The nurse is caring for an older adult client who is prescribed a benzodiazepine. When planning the client’s assessment, the nurse should be aware of what possible adverse effect? A) acute renal failure B) unpredictable reactions C) epistaxis D) dysuria

Ans: B

Feedback: Use benzodiazepines with caution in older adults or debilitated clients because of the possibility of unpredictable reactions and in clients with renal or hepatic dysfunction, which may alter the metabolism and excretion of these drugs, resulting in direct toxicity. Dosage adjustments usually are needed for such clients. Acute renal failure, dysuria, and epistaxis (nosebleed) are not commonly related to therapy with these medications in older adults.

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20. The nurse is caring for a client who has not been able to sleep. The health care provider orders a barbiturate medication for this client. What health education should the nurse provide? A) warning the client about the possibility of double vision B) teaching the client about the need for follow-up blood work C) teaching the client to report tinnitus promptly D) warning the client about the possibility of thought abnormalities

Ans: D

Feedback: The most common adverse effects are related to general central nervous system (CNS) depression. CNS effects may include drowsiness, somnolence, lethargy, ataxia, vertigo, resembling a “hangover,” thinking abnormalities, paradoxical excitement, anxiety, and hallucinations. Barbiturate drugs generally do not cause double vision or tinnitus. Blood levels are not normally needed.

Format: Multiple Choice Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 345, Benzodiazepines Used as Anxiolytics 21. An older adult client presents to the clinic and is diagnosed with generalized anxiety disorder (GAD). The health care provider (HCP) orders oral flurazepam 30 mg PO at bedtime. What is the nurse’s priority action? A) Teach the client about the prescribed medication. B) Administer the first dose of medication. C) Tell the client to take first dosage after driving home. D) Talk to the HCP about the dosage.

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Ans: D

Feedback: If an anxiolytic or hypnotic agent is the drug of choice for an older adult client, the smallest possible dose should be used, and the client should be monitored very closely during the first week of treatment. Dosage adjustments are necessary to achieve the most effective dose with the fewest adverse effects. In addition, older adults also require careful titration of dosage. Older clients may be more susceptible to the adverse effects of these drugs, from unanticipated central nervous system (CNS) adverse effects including increased sedation, dizziness, and even hallucinations. Dosages of all of these drugs should be reduced, and the client should be monitored very closely for toxic effects and to provide safety measures if CNS effects do occur. As a result, the priority action is to talk to the HCP about the dosage. The other actions may be appropriate after a proper dosage is ordered.

Format: Multiple Choice Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 344, Benzodiazepines Used as Anxiolytic–Hypnotics 22. The nurse is caring for a client who has a sedative hypnotic ordered. The nurse should consider this drug contraindicated if the client has what disorder? A) neurological diseases B) liver failure C) endocrine disorders D) heart disease

Ans: B

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Feedback: Benzodiazepines undergo extensive hepatic metabolism. In the presence of liver disease, the metabolism of most benzodiazepines is slowed, with resultant accumulation and increased risk of adverse effects. Neurological disorders, endocrine disorders, and heart disease are not contraindications for the use of benzodiazepines.

Format: Multiple Choice Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 348, Intervention with Rationale 23. A client with a history of epilepsy is taking a benzodiazepine. The nurse evaluates teaching as effective when the client makes which statement? A) “I should always take the medication with meals.” B) “I should not stop this drug without talking to my health care provider first.” C) “I should not take aspirin with this medication.” D) “I should avoid grapefruit juice for the duration of treatment.”

Ans: B

Feedback: The client makes a correct statement when saying the drug should not be stopped without talking to the health care provider first because withdrawal of benzodiazepines requires careful monitoring and should be gradually withdrawn. Acute withdrawal could precipitate seizures in this client. Medications do not have to be taken with food, aspirin is not contraindicated, and the medication need only be taken while the condition being treated continues. Grapefruit juice is not contraindicated.

Format: Multiple Selection Chapter: 20

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 348, Intervention with Rationale 24. The nurse evaluates teaching as effective when a client taking a benzodiazepine makes what statement? Select all that apply. A) “I should notice a lessening of my anxiety.” B) “I could fall so I must be careful when I take the medication.” C) “I should empty my bladder before taking this medication.” D) “I should avoid smoking for the duration of treatment.” E) “I’ll arrange for my daughter to do all my shopping so I don’t risk catching a cold while I’m out.”

Ans: A, B, C

Feedback: The sedative properties of the medication increase the risk of falling. Voiding before taking the medication will help minimize the risk of falls. This classification of medications should decrease anxiety. While smoking is generally discouraged, it has no particular relevance to this mediation therapy. Benzodiazepines are not generally associated with negatively affecting the immune system.

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25. The nurse administers promethazine to the client before sending the client to the preoperative holding area. What outcome demonstrates therapeutic effects? A) The client is conscious but drowsy. B) The client is unresponsive to verbal and physical stimuli. C) The client’s blood pressure is below 130/80 mm Hg. D) The client is asleep.

Ans: A

Feedback: Antihistamines (promethazine, diphenhydramine) can be very sedating in some people. They are used as preoperative medications and postoperatively to decrease the need for narcotics. The goal, however, is not to make the client unresponsive or asleep. No effect on blood pressure is intended.

Format: Multiple Selection Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 350, Barbiturates Used as Anxiolytic–Hypnotics 26. A client states that they were prescribed barbiturates many years ago for anxiety. The nurse explains that this is no longer done and should provide what rationales? Select all that apply. A) Adverse effects can be severe. B) There is a high risk of physical tolerance. C) There is a high risk of psychological dependence. D) Many clients develop cardiac arrhythmias. E) Hypersensitivity reactions can sometimes be fatal.

Ans: A, B, C, E

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Feedback: The adverse effects caused by barbiturates are more severe than those associated with other, newer sedatives/hypnotics. For this reason, barbiturates are no longer considered the mainstay for the treatment of anxiety. In addition, the development of physical tolerance and psychological dependence is more likely with the barbiturates than with other anxiolytics. The most common adverse effects are related to central nervous system (CNS) depression. Hypersensitivity reactions to barbiturates are sometimes fatal.

Format: Multiple Selection Chapter: 20 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 344, Benzodiazepines Used as Anxiolytic–Hypnotics 27. A client in their first trimester of pregnancy is anxious and has requested a benzodiazepine. The nurse should state that this is not normally done due to the risks of what anomalies? Select all that apply. A) cleft lip or palate B) inguinal hernia C) cardiac defects D) microcephaly E) gastroschises

Ans: A, B, C, D

Feedback: Benzodiazepines are contraindicated in pregnancy because a predictable syndrome of cleft lip or palate, inguinal hernia, cardiac defects, microcephaly, or pyloric stenosis occurs when they are taken in the first trimester. Gastroschises, when the

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abdominal organs are found outside the abdominal cavity, is not associated with the use of benzodiazepine use in the first trimester.

Format: Multiple Choice Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 344, Benzodiazepines Used as Anxiolytic–Hypnotics 28. The nurse is caring for a neonate whose birth parent took benzodiazepines for anxiety during the last 2 months of their pregnancy after a family tragedy. What is the nurse’s best action? A) Assess for newborn withdrawal syndrome. B) Administer flumazenil to the neonate as prescribed. C) Assess the infant’s pupillary reflex. D) Establish intravenous access.

Ans: A

Feedback: Neonatal withdrawal syndrome may result in a baby born to a birth parent who was taking benzodiazepines in the final weeks of pregnancy. The neonate may be given very small doses of benzodiazepines, not flumazenil, that are withdrawn gradually to prevent symptoms. IV access may or may not be necessary, and pupillary reflexes are not normally affected.

Format: Multiple Selection Chapter: 20 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Easy

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Integrated Process: Nursing Process Objective: 1 Page and Header: 343, States Affected by Anxiolytic and Hypnotic Drugs 29. The nurse is caring for a client who received a new diagnosis of cancer. The client exhibits signs of a sympathetic stress reaction. What sign(s) and symptom(s) will the nurse assess in this client consistent with an acute reaction to stress? Select all that apply. A) diaphoresis B) tachycardia C) tachypnea D) hypotension E) confusion

Ans: A, B, C

Feedback: Anxiety is often accompanied by signs and symptoms of the sympathetic stress reaction that may include diaphoresis (profuse sweating), fast heart rate, rapid breathing, and elevated blood pressure. Confusion is atypical.

Format: Multiple Choice Chapter: 20 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 343, Introduction 30. The nurse is caring for an older adult in the long-term care facility who has begun to display signs of anxiety and insomnia. What is the priority nursing action? A) Assess the client for physical problems. B) Call the provider and request an antianxiety drug order. C) Increase the client’s social time, encouraging interaction with others.

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D) Suggest the family visit more often to reduce the resident’s stress level.

Ans: A

Feedback: The client should be screened for physical problems, neurological deterioration, or depression, which could contribute to the insomnia or anxiety. Only after physical problems are ruled out would the nurse consider nondrug measures such as increased socialization with other residents or family members. If nothing else is effective, pharmacological intervention may be necessary.

Format: Multiple Selection Chapter: 20 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 343, States Affected by Anxiolytic and Hypnotic Drugs 31. A client with a 10-year history of alcohol abuse has been admitted after experiencing an open reduction for a fractured femur. What assessment data suggest that the client is experiencing alcohol withdrawal? Select all that apply. A) reports, “I feel like I’m going to throw-up” B) heart rate has become slight irregular C) reports, “My leg feels numb” D) hand tremors that make holding a cup difficult E) demonstrates extreme irritability and is uncooperative

Ans: A, B, D, E

Feedback: Withdrawal symptoms can range from nausea and vomiting to tonic–clonic seizures and delirium. Some people suffer from tremors and restlessness or irritability.

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Others may have variability in vital signs and cardiac arrhythmias. The numbness is more possibly related to the surgery anesthetic.

Ans: A

Feedback: The client’s history of drug abuse suggests the possibility of opioid withdrawal. Naltrexone is an opioid antagonist that can be used to suppress alcohol cravings and opioid withdrawal. Disulfiram is a medication that blocks the metabolism of alcohol so that, if used concurrently with alcohol, highly unpleasant side effects occur. Acamprosate is also a medication used to enhance alcohol abstinence, but its mechanism of action is different. Alprazolam is prescribed to treat anxiety.

Test Generator Questions, Chapter 21, Antidepressant Agents Format: Multiple Selection Chapter: 21

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Client Needs: Psychosocial Integrity Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 359, Depression and Antidepressants 1. After seeking care for persistent exhaustion and sadness, a client has been diagnosed with depression. The nurse should be aware of what potential contributing factors? Select all that apply. A) serotonin deficiency B) low levels of norepinephrine C) excessive cortisol levels D) high levels of thyroid-stimulating hormone and thyroxine E) dopamine deficiency

Ans: A, B, E

Feedback: A current hypothesis regarding the cause of depression is a deficiency of norepinephrine, dopamine, or serotonin, which are all biogenic amines, in key areas of the brain. Thyroid hormone and cortisol levels have not been implicated in the etiology of depression.

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2. An older adult was diagnosed with depression several decades ago and has been taking tricyclic antidepressants (TCAs) ever since, with good effect. The nurse should recognize what therapeutic action of this client’s medication? A) inhibiting monoamine oxidase inhibitors that break down norepinephrine B) inhibiting generalized neuron activity, preventing overexcitability or stimulation C) blocking the reuptake of serotonin, which increases the levels of norepinephrine D) inhibiting reuptake of 5HT and NE

Ans: D

Feedback: TCAs inhibit presynaptic reuptake of the neurotransmitters 5HT and NE, which cause an accumulation of the neurotransmitters that is thought to create the antidepressant effect. Monoamine oxidase inhibitors irreversibly inhibit monoamine oxidase that breaks down norepinephrine and serotonin. Selective serotonin reuptake inhibitors block the reuptake of serotonin; gamma-aminobutyric acid inhibits nerve activity.

Format: Multiple Choice Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 359, Depression and Antidepressants 3. A nurse is working with a 9-year-old child who exhibits signs and symptoms of obsessive–compulsive disorder (OCD). What nursing action is most likely to be appropriate? A) Educate the family about the safe and effective use of phenelzine. B) Assist the family with accessing cognitive–behavioral therapy. C) Provide health education about fluvoxamine. D) Ensure that the provider assesses the client’s cortisol levels.

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Ans: C

Feedback: Fluvoxamine is a selective serotonin reuptake inhibitor that has established pediatric dosage guidelines for the treatment of obsessive–compulsive disorder. Phenelzine is monoamine oxidase inhibitors and should be avoided in pediatric use because of the potential drug–food interactions and other serious adverse effects. Cognitive–behavioral therapy may or may not be recommended, and there is no obvious indication for testing around cortisol levels.

Format: Multiple Choice Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 2 Page and Header: 361, Tricyclic Antidepressants 4. A client explains to a nurse that they have been taking amitriptyline for depression, achieving a modest improvement in mood. The provider recently changed the client’s medication to clomipramine. The client is confused and does not understand why their medication was changed to “the same type of drug.” What is the nurse’s best response? A) “These drugs are similar but some clients respond better to one than the other.” B) “Did you have your follow-up blood work drawn on schedule as was recommended?” C) “It’s likely that your provider is trying to rule out psychological causes for your depression.” D) “It’s likely that your provider felt that clomipramine would have fewer side effects.”

Ans: A

Feedback: Because all tricyclic antidepressants (TCAs) are similarly effective, the choice of which TCA depends on individual response to the drug and tolerance of adverse

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effects. A client who does not respond to one TCA may respond to another drug from this class. The nurse should avoid speculating about the rationale for the change, but it is unlikely that a difference in adverse effects motivated the change, as these are likely to be similar. Depression is multifactorial, and it is not possible to “rule out” psychological factors. Follow-up blood work is not normally necessary with TCAs.

Format: Multiple Choice Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 367, Selective Serotonin Reuptake Inhibitors 5. The client tells the nurse that they has been taking oral fluoxetine 20 mg daily for the past 3 weeks and has lost 2 lb (0.9 kg) during that time due to a loss of appetite. What action should the nurse take? A) reassuring the client that the weight loss is due to diuresis and will resolve once fluid balance is restored B) recommending the use of over-the-counter multivitamin supplements C) encouraging the client to increase fat intake to avoid further weight loss D) reassuring the client that this is a common adverse effect with this medication

Ans: D

Feedback: Adverse effects of fluoxetine include anorexia and weight loss. This client’s weight loss is modest and would not likely necessitate a change in drug therapy. Although teaching about healthy eating is a good idea, it is more important to teach the client how to take the medication in a way that will reduce adverse effects as well as how to optimize healthy calories to maintain weight. The client should increase caloric intake, not just fluid intake. It would not be healthy to recommend exclusively increasing fat intake. The client should continue the medication to see whether therapeutic effects

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are obtained and adjust nutritional intake if necessary. This weight loss is not solely due to fluid loss. Multivitamins will not reduce weight loss.

Format: Multiple Choice Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 364, Monoamine Oxidase Inhibitors 6. A client’s depression has not responded to conservative treatments, and the provider has prescribed phenelzine. The client’s comorbidities include rheumatoid arthritis and type 1 diabetes. What assessment should the nurse prioritize? A) assessment for signs and symptoms of hypoglycemia B) assessment for indications of spontaneous tendon rupture C) assessment of range of motion and assessment for joint locking D) assessment for diabetic ketoacidosis (DKA)

Ans: A

Feedback: A client with type 1 diabetes likely takes insulin, and MAOIs can cause an additive hypoglycemic effect if taken with insulin or oral diabetic agents. DKA is associated with hyperglycemia, not hypoglycemia. This client would have to be monitored closely and appropriate dosage adjustments in insulin made. There is no heightened risk of orthopedic complications.

Format: Multiple Choice Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 367, Selective Serotonin Reuptake Inhibitors 7. A client taking fluoxetine for the past 2 months for depression is seeing their gynecologist for premenopausal symptoms. During an interview with the nurse, the client says, “I’m interested in trying Sarafem because my friend is taking it, and she says it works great.” What is the nurse’s best response? A) “Sarafem is a brand name for fluoxetine.” B) “Before changing drugs, it is important to give you enough time to respond to fluoxetine.” C) “You cannot safely take both drugs at the same time so it will be important for you and your provider to decide which is best.” D) “When taking both of these drugs, you’ll likely be encouraged to take one in the morning and one at night.”

Ans: A

Feedback: Prozac and Sarafem are different brand names for fluoxetine, so there is no benefit in changing the client’s medication regimen and, if taken together, would result in a drug overdose. The other three responses are incorrect or inappropriate because they do not reflect the fact that both drugs are the same.

Format: Multiple Choice Chapter: 21 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 367, Selective Serotonin Reuptake Inhibitors

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8. An 11-year-old client has been hospitalized with severe depression. For the past several weeks, the client has been prescribed a selective serotonin reuptake inhibitor (SSRI). What is the priority nursing action? A) Monitor food intake and eliminate potential sources of tyramine. B) Assess for weight loss and difficulty sleeping. C) Monitor the client for migraines. D) Implement suicide precautions.

Ans: D

Feedback: Recent studies have linked the incidence of suicide attempts to the use of SSRIs in pediatric clients. The priority concern for the nurse would be safety for the client. Severe headaches and reactions to tyramine-containing foods are associated with monoamine oxidase therapy, not SSRIs. Weight loss and difficulty sleeping are of a lower priority concern than the client’s safety.

Format: Multiple Choice Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 370, Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) 9. The nurse provides care for several clients who are taking antidepressants. Which client should the nurse assess most closely for signs of addiction and anxiety? A) a client who has experienced unexpected weight loss while taking fluoxetine B) a client who was recently been prescribed venlafaxine C) a client for whom electroconvulsive therapy (ECT) is being considered D) a 77-year-old client being treated with an SSRI

Ans: B

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Feedback: Venlafaxine is used to treat and prevent depression in generalized anxiety disorder, social anxiety disorder; it also diminishes addictive behavior. The nurse should assess for these factors if the client is taking this medication. Fluoxetine and the other SSRIs do not have this specific indication. The fact that ECT is being considered suggests a client’s depression is severe but not necessarily characterized by anxiety and depression.

Format: Multiple Choice Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 367, Selective Serotonin Reuptake Inhibitors 10. A client receives a new prescription for fluvoxamine. What should the nurse teach the client about taking the medication? A) Take the medication shortly after eating breakfast. B) Take medication with at least 8 oz of liquid. C) The dosage may need to be increased if the client is not feeling better in 2 weeks. D) The medication should be taken once a day before bedtime.

Ans: D

Feedback: Fluvoxamine is a selective serotonin reuptake inhibitor that should be taken once a day before bedtime. The medication does not require 8 ounces of fluid for absorption. It should be taken for at least 4 weeks before a therapeutic effect is noted.

Format: Multiple Choice Chapter: 21

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 364, Monoamine Oxidase Inhibitors 11. The client presents to the emergency department with a headache in the back of the head, diaphoresis, and neck stiffness. The client’s blood pressure measures 180/124 mm Hg and heart rate is 168 beats/min. The spouse says the client is currently prescribed “something for depression” and denies any history of cardiac disease. The nurse should suspect the use of what medication? A) a monoamine oxidase inhibitor (MAOI) B) a selective serotonin reuptake inhibitor (SSRI) C) a tricyclic antidepressant (TCA) D) an atypical antipsychotic

Ans: A

Feedback: MAOIs have several serious adverse effects that can be fatal. This client’s symptoms indicate fatal hypertensive crisis characterized by occipital headache, palpitations, neck stiffness, nausea, vomiting, sweating, dilated pupils, photophobia, tachycardia, and chest pain. It may progress to intracranial bleeding and fatal stroke. SSRIs and TCAs are not associated with these particular symptoms. Antipsychotics do not have this effect.

Format: Multiple Choice Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 2

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Page and Header: 361, Tricyclic Antidepressants 12. A client’s current medication regimen includes clomipramine, but the client denies any history of depression. For what other health problem should the nurse assess the client? A) early-onset Alzheimer’s disease B) schizophrenia C) Parkinson’s disease D) obsessive–compulsive disorder (OCD)

Ans: D

Feedback: Clomipramine is now also approved for use in the treatment of OCD. This medication is not used for the treatment of dementia, schizophrenia, or Parkinson’s disease.

Format: Multiple Choice Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 367, Selective Serotonin Reuptake Inhibitors 13. The nurse is assessing a client whose medication regimen includes fluvoxamine 150 mg PO daily. The client denies a history of depression. What assessment question should the nurse subsequently ask? A) “Do you have any history of obsessive thoughts of compulsive habits?” B) “Have you ever had a Mini-Mental Status Exam performed?” C) “Have you ever had any thoughts about deliberately harming yourself?” D) “Does anyone else in your family have a history of depression?”

Ans: A

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Feedback: Fluvoxamine is indicated for the treatment of obsessive–compulsive disorder and is classified as a selective serotonin reuptake inhibitor (SSRI). The MMSE is used to screen for cognitive deficits, which are not likely in this client. Suicide risk is a relevant assessment for all clients, but this client denies a history of depression, so this may not be prioritized over assessing for OCD. The client’s family history of depression is not a central concern.

Format: Multiple Choice Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 361, Tricyclic Antidepressants 14. The client has been depressed since their father died 6 months ago. The health care provider has prescribed amitriptyline. What aspect of this client’s health history should prompt the nurse to contact the health care provider? A) osteoporosis B) ischemic heart disease C) concussion 10 months ago D) gastroesophageal reflux disease (GERD)

Ans: B

Feedback: Caution should be used with tricyclic antidepressants in clients with preexisting cardiovascular (CV) disorders because of the cardiac stimulatory effects of the drug and with any condition that would be exacerbated by the anticholinergic effects (e.g., angle-closure glaucoma, urinary retention, prostate hypertrophy, GI, or genitourinary surgery). There is no indication that caution is needed with clients

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diagnosed with osteoporosis or GERD. A concussion would be significant if it were more recent than 10 months ago.

Format: Multiple Selection Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 366, Nursing Considerations for Patients Receiving Monoamine Oxidase Inhibitors 15. A client diagnosed with depression has been prescribed a monoamine oxidase inhibitor (MAOI). What education should the nurse provide to this client? Select all that apply. A) Take the medication at bedtime with plenty of fluids. B) Monitor blood pressure closely. C) Do not take over-the-counter (OTC) drugs without talking to the health care provider. D) Expect tarry stools near the beginning of treatment. E) Avoid foods containing tyramines.

Ans: B, C, E

Feedback: MAOIs can cause drug–drug and drug–food interactions, which can precipitate cardiovascular effects that include orthostatic hypotension, arrhythmias, palpitations, angina, and the potentially fatal hypertensive crisis. Priority teaching points include monitoring blood pressure, which will elevate with tyramine ingestion, and the importance of not taking any OTC without health care provider or pharmacist consultation due to multiple drug–drug interactions. When taking an MAOI, the nurse would not necessarily take the drug at bedtime or drink lots of fluid. Tarry stools are not expected.

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Format: Multiple Selection Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 361, Tricyclic Antidepressants 16. A client hospitalized with a diagnosis of depression has been prescribed amitriptyline. For what common adverse effects should the nurse monitor the client? Select all that apply. A) fever B) constipation C) drowsiness D) dry mouth E) gynecomastia

Ans: B, C, D

Feedback: Use of tricyclic antidepressants may lead to GI anticholinergic effects, such as dry mouth, constipation, drowsiness, nausea, vomiting, anorexia, increased salivation, cramps, and diarrhea. Fever and gynecomastia are not normally attributed to amitriptyline therapy.

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Page and Header: 361, Tricyclic Antidepressants 17. The nurse is caring for an 8-year-old client who takes imipramine. The nurse should assess this child for a history of what health problem? A) enuresis (bed-wetting) B) obsessive–compulsive disorder (OCD) C) oppositional defiant disorder D) psoriasis Ans: A

Feedback: One of the indications for use of the drug imipramine is enuresis in children older than 6 years. Imipramine is not indicated for the treatment of OCD, oppositional defiant disorder, or psoriasis.

Format: Multiple Choice Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 359, Depression and Antidepressants 18. A 10-year-old client is being seen by a pediatric psychiatrist for severe depression. What antidepressant is approved for administration to this child? A) trazodone B) nortriptyline C) fluvoxamine D) phenelzine

Ans: B

Feedback: Nortriptyline has established pediatric doses and can be used in children older than 6 years, but such children should be monitored closely for adverse effects.

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Phenelzine is a monoamine oxidase inhibitor (MAOI), a class of drugs that should be avoided in children if at all possible because of the potential for drug–food interactions and the serious adverse effects. Trazodone can be used with children but is not a firstline drug because it has many adverse effects on the central nervous system associated with its use. Fluvoxamine is an SSRI that can be used in children to treat obsessive– compulsive disorder, but selective serotonin reuptake inhibitors can cause serious adverse effects in children.

Format: Multiple Choice Chapter: 21 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 1 Page and Header: 359, Depression and Antidepressants 19. A client’s depression is believed to exist because of a deficiency of biogenic amines in key areas of the client’s brain. What phenomenon would be most likely to cause this deficiency? A) A slowing of the action of the neurons may lead to their depletion. B) Monoamine oxidase (MAO) strengthening the impact of biogenic amines. C) Increase in the number or sensitivity of postsynaptic receptors. D) Depletion of norepinephrine because biogenic amines feed off of loose particles of the neurotransmitter.

Ans: C

Feedback: The three reasons for depression according to the biogenic amine theory include the following: (1) MAO may break down biogenic amine to be recycled or restored in the neuron; (2) rapid fire of the neurons may lead to their depletion; (3) the number or sensitivity of postsynaptic receptors may increase, thus depleting neurotransmitter levels. Amines do not “feed off of” other neurotransmitters.

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Format: Multiple Choice Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 367, Selective Serotonin Reuptake Inhibitors 20. The client with which eye-related diagnoses should be cautioned about the use of a selective serotonin reuptake inhibitor (SSRI)? A) narrow-angle glaucoma B) cataracts C) infection D) strabismus

Ans: A

Feedback: SSRIs may also cause serious intraocular pressure changes if used in clients with untreated narrow-angle glaucoma. None of the other options are related to intraocular pressure abnormalities.

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21. A 29-year-old female client diagnosed with depression has prescribed venlafaxine. When providing health education, the nurse should describe what benefit of this medication when compared with other similar medications? A) Beneficial effects on mood and affect can be experienced in as little as 48 hours. B) An intramuscular depot dose of the medication can be administered one time per week. C) It is the only widely prescribed antidepressant that can be safely taken during pregnancy. D) An extended-release form is available, eliminating the need for repeated doses during the day.

Ans: D

Feedback: Venlafaxine’s popularity has increased with the introduction of an extendedrelease form that does away with the multiple daily doses that are required with the regular form. Adequate studies have not been done in pregnancy and lactation, so that it should be used during those times only if the benefit to the mother clearly outweighs the potential risk to the neonate. It is taken orally, which is the case with most antidepressants. As with all antidepressants, symptom relief takes days or weeks to be felt.

Format: Multiple Choice Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 359, Depression and Antidepressants 22. During initial admission assessment, a 79-year-old client’s family mention that the client’s spouse died 4 months ago. One family member notes, “the health care provider

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had prescribed antidepressant medication” but the client is “talking to people who aren’t there.” What would the nurse suspect is happening to the client? A) The client is having hallucinations as an adverse effect of antidepressant therapy. B) The mental status change is a paradoxical medication effect. C) The client probably has a urinary tract infection, caused by changes in pH from the antidepressant. D) The client is having delusions because of their depression over the loss of their spouse.

Ans: A

Feedback: Older adult clients may be more susceptible to the adverse effects of antidepressants from unanticipated central nervous system effects to increased sedation, dizziness, and even hallucinations. Although an infection cannot be ruled out without further testing, the history would lead the nurse to the antidepressants as the most likely cause. This is not a paradoxical effect, which is understood as the opposite of the desired therapeutic effect.

Format: Multiple Choice Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 367, Selective Serotonin Reuptake Inhibitors 23. For which client would the black box warning regarding antidepressants be most relevant? A) an 89-year-old client who is distraught after the recent death of their spouse B) a 12-year-old child who has been diagnosed with depression by a pediatric psychiatrist C) a 32-year-old client who uses oral contraceptives and who has depression

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D) a 62-year-old client who has depression and ischemic heart disease

Ans: B

Feedback: A black box warning was added to all antidepressants bringing attention to the increase in suicidality, especially in children and adolescents, when these drugs were used. This warning does not address the other listed clients.

Format: Multiple Selection Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 367, Selective Serotonin Reuptake Inhibitors 24. The nurse is caring for a client who has been diagnosed with depression and prescribed sertraline on an outpatient basis. The nurse should warn the client about what possible adverse effect(s)? Select all that apply. A) agitation B) acne on the face and trunk C) insomnia D) photosensitivity E) dry mouth

Ans: A, C, E

Feedback: The adverse effects associated with selective serotonin reuptake inhibitors, which are related to the effects of increased 5-hydroxytryptamine levels, include central nervous system effects (e.g., headache, drowsiness, dizziness, insomnia, anxiety, tremor, agitation, seizures). Gastrointestinal effects (e.g., nausea, vomiting, diarrhea, dry mouth, anorexia, constipation, changes in taste) often occur, as do genitourinary

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effects (e.g., painful menstruation, cystitis, sexual dysfunction, urgency, impotence). Adverse effects of sertraline do not include acne or photosensitivity.

Format: Multiple Choice Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 361, Tricyclic Antidepressants 25. The nurse is caring for an older adult client who is taking amitriptyline for depression. What teaching will the nurse include in the teaching plan to help the client monitor for adverse effects? A) “If mild chest pain occurs, an over-the-counter pain reliever will help.” B) “Nasal congestion suggests that the drum might not be effective.” C) “Measure and record your blood pressure daily.” D) “Adverse effects will subside as you adjust to the medication.”

Ans: C

Feedback: Cardiovascular effects of tricyclic antidepressants like amitriptyline include orthostatic hypotension, hypertension, arrhythmias, myocardial infarction, angina, palpitations, and stroke. Miscellaneous reported effects include alopecia, weight gain or loss, flushing, chills, and nasal congestion. Teaching the client how and when to monitor blood pressure would be an important teaching point. Chest pain could be a serious finding, and clients should be taught to call 911. Nasal congestion is a possible adverse effect of the drug and not an indication of ineffectiveness. Adverse effects often will not subside and may continue so long as the drug is taken.

Format: Multiple Choice

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Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 367, Selective Serotonin Reuptake Inhibitors 26. The nurse is caring for a client who was referred to a psychiatrist for treatment of a severe anxiety disorder. What medication would the nurse consider appropriate for this client? A) chlorpromazine 25 mg three times daily orally B) benztropine 2 mg twice daily orally C) clozapine 200 mg twice daily orally D) paroxetine 10 mg once daily orally

Ans: D

Feedback: Paroxetine is a selective serotonin reuptake inhibitor indicated for the treatment of depression, obsessive–compulsive disorder, panic attacks, bulimia, premenstrual dysphoric disorder, posttraumatic stress disorders, social phobias, and social anxiety disorders. Chlorpromazine and clozapine are antipsychotic medications, whereas benztropine is a drug used to treat Parkinson’s disease. None of these would be appropriate options to treat anxiety disorders.

Format: Multiple Choice Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 364, Monoamine Oxidase Inhibitors

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27. A client has been prescribed oral tranylcypromine 10 mg b.i.d. for atypical depression. When prescribed in this manner, when would the nurse expect the drug to reach peak levels in the body? A) 1 to 2 hours after taking the drug B) 2 to 3 hours after taking the drug C) 3 to 4 days after starting the drug D) 4 to 5 weeks after starting the drug

Ans: B

Feedback: The monoamine oxidase inhibitors are well absorbed from the GI tract, reaching peak levels in 2 to 3 hours. The other time frames are incorrect.

Format: Multiple Choice Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 370, Nursing Care Guide for D.J.: Fluoxetine 28. The nurse is creating a care plan for a client taking a selective serotonin reuptake inhibitor (SSRI). What would be an appropriate nursing conclusion for this client? A) risk for infection related to immunosuppressant effects of medication B) risk for impaired skin integrity related to vasodilation and delayed wound healing C) disturbed thought processes related to CNS effects of medication D) risk for autonomic dysreflexia related to CNS effects of medication

Ans: C

Feedback: Nursing conclusions related to SSRI therapy might include disturbed thought processes related to central nervous system effects because adverse effects of SSRIs

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include headache, drowsiness, dizziness, insomnia, anxiety, tremor, agitation, and seizures. There would be no reason to expect the client is at increased risk for infection. Autonomic dysreflexia applies to clients with spinal cord injury. SSRIs do not affect skin integrity, immunity, or wound healing.

Format: Multiple Choice Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 366, Nursing Considerations for Patients Receiving Monoamine Oxidase Inhibitors 29. A client is admitted with a presumed diagnosis of colon cancer. The health record indicates that the client takes a monoamine oxidase inhibitor for depression. What drug should the nurse keep on hand for this client in case of the onset of an adverse reaction? A) epinephrine B) naloxone C) acetylcysteine D) phentolamine

Ans: D

Feedback: The nurse should have phentolamine or another adrenergic blocker on standby as treatment in case of hypertensive crisis, which can be caused by MAOIs. Epinephrine would exacerbate hypertension. Acetylcysteine is an antidote for acetaminophen overdose. Naloxone treats opioid overdoses.

Format: Fill-in-the-Blank Chapter: 21

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 373, Other Antidepressants 30. A 9-year-old child with a traumatic family history has been diagnosed with depression and prescribed trazodone 1.5 mg/kg PO daily in three divided doses. The child weighs 88 lbs. How many 40-mg tablets should the nurse administer for each dose?

Ans: 0.5 tablets

Feedback: The child’s weight must first be converted to kilograms by dividing the weight in pounds by 2.2. This gives a weight of 40 kg. The child is to receive 1.5 mg/kg, and 1.5 mg × 40 kg = 60 mg/day. The drug is ordered in three doses, so dividing 60 mg by 3 = 20 mg per dose. Each tablet contains 40 mg: 20 mg ÷ 40 mg/tablet = 0.5 tablets.

Format: Multiple Selection Chapter: 21 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 359, Depression and Antidepressants 31. When a new adult client arrives at a mental health clinic reporting feelings of depression, what condition(s) should be screened for before the client is prescribed antidepressants? Select all that apply. A) thyroid disease B) hormonal imbalance

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C) cardiovascular disorders D) Parkinson’s disease E) diabetes mellitus

Ans: A, B, C

Feedback: Adults using these drugs should have physical causes for their depression ruled out before therapy is begun. Thyroid disease, hormonal imbalance, and cardiovascular disorders can all lead to the signs and symptoms of depression. There is no indication that Parkinson’s disease or diabetes is manifested by depression.

Format: Multiple Choice Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 364, Monoamine Oxidase Inhibitors 32. The nurse is teaching a client taking a monoamine oxidase inhibitor (MAOI) about dietary changes required to minimize adverse effects of the drug. The nurse determines the client understands a low-tyramine diet when what meal is chosen? A) a chop salad with blue cheese, sardines, and pepperoni B) a sandwich with turkey, avocado, and Swiss cheese C) corned beef hash, eggs, and hash browns D) a hamburger, French fries, and a strawberry milkshake

Ans: D

Feedback: Hamburger, French fries, and a strawberry milkshake do not contain tyramine and, although high in fat, it would not be contraindicated for a client taking an

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MAOI. Blue cheese, sardines, pepperoni, Swiss cheese, and corned beef are all high in tyramine and would indicate further teaching was needed.

Format: Multiple Choice Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 367, Selective Serotonin Reuptake Inhibitors 33. What drug should the nurse consider contraindicated for the client taking a monoamine oxidase inhibitor (MAOI)? A) escitalopram B) insulin C) acetaminophen D) docusate

Ans: A Feedback: SSRIs are contraindicated because of a life-threatening serotonin syndrome that could occur. If a client requires insulin, the benefit outweighs the risk but careful monitoring of glucose levels is needed because effects of insulin may be additive with an MAOI. There is no known contraindication for acetaminophen or docusate.

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Page and Header: 367, Selective Serotonin Reuptake Inhibitors 34. The nurse is caring for a young female client who is 5 weeks pregnant. What statement made by the nurse about the use of antidepressants during pregnancy is most accurate? A) “Antidepressants are used very cautiously during pregnancy and only when benefit outweighs risk.” B) “Antidepressants are contraindicated and must be discontinued if pregnancy occurs.” C) “Antidepressants must be chosen carefully because only a few are safe during pregnancy.” D) “Most antidepressants are safe during pregnancy but those that are contraindicated should be avoided.”

Ans: A

Feedback: Antidepressants should be used very cautiously during pregnancy and lactation because of the potential for adverse effects on the fetus and possible neurological effects on the baby. Use should be reserved for situations in which the benefits to the mother far outweigh the potential risks to the neonate.

Format: Multiple Choice Chapter: 21 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 367, Selective Serotonin Reuptake Inhibitors 35. When providing medication information to a client prescribed a serotonin and norepinephrine reuptake inhibitor (SNRI), what herbal supplement should the client be cautioned to avoid? A) primrose B) St. John’s wort

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C) valerian D) ginseng

Ans: A

Feedback: Clients being treated with selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are at an increased risk of developing a severe reaction, including serotonin syndrome, as well as increased sensitivity to light if they are also taking St. John’s wort. Because this herbal therapy is often used to self-treat depression, it is important to forewarn any client who is taking an SSRI not to combine it with taking St. John’s wort. Also caution clients that there is an increased risk of seizures if evening primrose is used with antidepressants. Interactions, not necessarily serotonin syndrome, have also been reported when antidepressants are combined with ginkgo, ginseng, and valerian.

Test Generator Questions, Chapter 22, Psychotherapeutic Agents Format: Multiple Choice Chapter: 22 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 377, Introduction 1. The nurse is providing care for a 72-year-old client whose diagnosis of bipolar disorder is treated with lithium. What nursing responsibility should be prioritized? A) Teach the client how to safely adjust doses based on symptoms. B) Monitor the client’s blood glucose levels and cognition. C) Monitor the client’s fluid balance and sodium intake. D) Educate the client about the signs and symptoms of tardive dyskinesia.

Ans: C

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Feedback: Older clients, and especially those with renal impairment, should be encouraged to maintain adequate hydration and salt intake. Decreased dosages may also be necessary with older adults. These drugs alone do not affect glucose levels, though cognition should be monitored. Lithium therapy is not associated with tardive dyskinesia. Clients should not unilaterally adjust their doses.

Format: Multiple Choice Chapter: 22 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 387, Drugs for Bipolar Disorders 2. The nurse is caring for a client who is taking lithium for the treatment of bipolar disorder. The client’s most recent laboratory findings reveal a serum lithium level of 1.4 mEq/L (1.4 mmol/L). What assessment findings should the nurse attribute to the client’s lithium level? A) The nurse observes personality changes, and the client is disoriented to time. B) Lung auscultation reveals rales, and the client is short of breath on exertion. C) The client is lethargic and weak. D) The client has decreased bowel sounds and has had no bowel movement for 3 days.

Ans: C

Feedback: The therapeutically effective serum level is 0.6 to 1.2 mEq/L (0.6 to 1.2 mmol/L). Lethargy and weakness are early indications of excessive of lithium levels. Diarrhea would be much more likely than constipation, and personality changes are not expected. Similarly, respiratory complications are atypical.

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Format: Multiple Choice Chapter: 22 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 384, Nursing Considerations for Patients Receiving Antipsychotic/Neuroleptic Drugs 3. The nurse administers chlorpromazine intramuscularly to the preoperative client who is intensely anxious about surgery the next morning. What education should the nurse provide this client? A) “Remain lying down for at least half an hour after the injection.” B) “Do not eat for around 1 hour after I give you the drug.” C) “Tell me right away if you feel numbness or tingling around your lips.” D) “It might burn a little bit when you pass urine the next time.”

Ans: A

Feedback: When giving a parenteral form of an antipsychotic, the client should remain recumbent to decrease the risk of injury if orthostatic hypotension occurs. Eating after drug injection should not interfere with the drug’s absorption because it is administered intramuscularly. Numbness, tingling, and dysuria are not expected adverse effects.

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4. The nurse is caring for a 6-year-old client who is being treated with methylphenidate. What assessments should the nurse prioritize in the care of this client? A) monitoring rates of long bone growth B) assessing visual acuity and tinnitus C) assessing the client’s weight and monitoring complete blood counts D) monitoring the client’s urine output and creatinine clearance

Ans: C

Feedback: Methylphenidate is associated with weight loss, bone marrow suppression, and cardiac arrhythmias. Weight, blood count, and cardiac function should be monitored regularly. The drug is not associated with renal dysfunction, visual changes, tinnitus, or growth retardation, so those values would not need to be regularly evaluated as part of drug therapy.

Format: Multiple Choice Chapter: 22 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 384, Nursing Considerations for Patients Receiving Antipsychotic/Neuroleptic Drugs 5. The nurse is caring for a client who has been taking an oral neuroleptic medication for several years. What assessment should the nurse prioritize to best address the risk for adverse effects? A) assessing bowel pattern and stool character B) monitoring the client’s cranial nerve function C) assessing deep tendon reflexes D) monitoring the client for involuntary facial movements

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Ans: D

Feedback: The nurse would monitor for and teach the client and family about tardive dyskinesias because it is such a common adverse effect with continued use of the drug. Clients do not normally experience disruptions to bowel function, cranial nerve function, or deep tendon reflexes.

Format: Multiple Choice Chapter: 22 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 378, Antipsychotic/Neuroleptic Drugs 6. A client experiencing psychosis is admitted through the emergency department and administered chlorpromazine 25 mg intramuscularly. After administration of the medication, what is the nurse’s priority assessment? A) pupillary reflexes B) apical heart rate and rhythm C) behavior and cognition D) postural blood pressures

Ans: C

Feedback: The nurse will evaluate the effectiveness of the drug in diminishing psychotic symptoms because this is the purpose of administering the drug. Monitoring blood pressure, pulse, and reflexes are necessary parts of client care but are not the priority evaluation criteria for this client.

Format: Multiple Choice

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Chapter: 22 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 389, Nursing Considerations for Patients Receiving Lithium 7. A client diagnosed with bipolar disorder is to be discharged to home in 48 hours. The nurse has completed client teaching regarding the use of lithium. What statement by the client best indicates an understanding of drug therapy? A) “I will make sure to stay out the sun.” B) “I will make sure I drink plenty of fluids.” C) “I’ll use over-the-counter stool softeners if I get constipated.” D) “I’ll come to the emergency department if I have any questions.”

Ans: B

Feedback: To maintain a therapeutic lithium level, the client must increase fluids. A decrease in consumption of fluids can lead to toxicity. There is likely no contraindication against the use of stool softeners, but this should be confirmed with the prescriber. The client should be provided with contact information for addressing any questions that they have, but the emergency department is rarely the best source. Lithium is not associated with photosensitivity.

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8. A client, hospitalized during the manic phase of bipolar I disorder, is being discharged home on an antimanic drug. What antimanic drug will best provide long-term maintenance of the client’s bipolar disorder? A) lurasidone B) lamotrigine C) haloperidol D) ziprasidone

Ans: A

Feedback: Lurasidone is used for long-term maintenance of bipolar I disorders. Lamotrigine and ziprasidone are used for acute manic and mixed episodes of bipolar disorders. Haloperidol is not used for the long-term treatment of bipolar disorder.

Format: Multiple Choice Chapter: 22 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 388, Box 22.4 Focus on Herbal and Alternative Therapies: Psyllium 9. When providing medication education to a client who has been newly prescribed lithium, what herbal supplement should the nurse stress avoiding due to its affect on the absorption of the medication? A) primrose B) psyllium C) St. John’s wort D) ginseng

Ans: B

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Feedback: Clients being treated with lithium should be encouraged not to use the herbal therapy psyllium, which is used to treat constipation and to lower cholesterol levels. If this agent is combined with lithium, the absorption of the lithium may be blocked, and the client will not receive a therapeutic level. None of the other options are necessarily contradicted by lithium therapy.

Format: Multiple Choice Chapter: 22 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1, 5 Page and Header: 378, Antipsychotic/Neuroleptic Drugs 10. The nurse is caring for an adolescent client who began taking an antipsychotic drug last month to treat newly diagnosed schizophrenia. The client’s symptoms have improved only slightly, and the client’s parents wonder if the client is “beyond hope.” What is the nurse’s best response? A) “It’s common for clients to have to try different drugs until the most effective one is identified. B) “Some clients do not respond to antipsychotic drugs and have to rely solely on cognitive–behavioral therapy.” C) “Do you feel like you’ve given the medication enough time to work?” D) “It might be necessary to take a combination of several antipsychotics before the benefits are seen.”

Ans: A

Feedback: A client who does not respond to one drug may react successfully to another agent. It is not common to have a client who does not demonstrate some improvement from medications so it would be incorrect to tell the parents that the child won’t respond to any drug after trying only one medication. It is not common for a client to require

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“several” antipsychotics concurrently. Asking “Do you feel like you’ve given the medication enough time to work?” is inappropriate: if the question is rhetorical, it is condescending; if it is genuine, it is not something the parents can determine.

Format: Multiple Choice Chapter: 22 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 378, Antipsychotic/Neuroleptic Drugs 11. A client’s thought disorder has been treated with haloperidol. For what adverse effect should the nurse most closely monitor the client? A) bradycardia B) shortness of breath C) extrapyramidal effects D) hypoglycemia

Ans: C

Feedback: Haloperidol produces a relatively low incidence of hypotension and sedation and a high incidence of extrapyramidal effects. Haloperidol does not generally produce bradycardia, shortness of breath, or hypoglycemia.

Format: Multiple Choice Chapter: 22 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 3 Page and Header: 388, Adverse Effects 12. What assessment data would the nurse expect to identify when the client’s serum lithium level is 2.2 mEq/L (2.2 mmol/L)? A) nausea and vomiting B) seizure C) fine hand tremors D) diarrhea

Ans: B

Feedback: Serum levels of 2 to 2.5 mEq/L (2 to 2.5 mmol/L) present with possible progression of CNS effects to ataxia, clonic movements, hyperreflexia, and seizures. Serum levels of <1.5 mEq/L (<1.5 mmol/L) present with CNS problems, including lethargy, slurred speech, muscle weakness, and fine tremor; polyuria, which relates to renal toxicity; and beginning of gastric toxicity, with nausea, vomiting, and diarrhea.

Format: Multiple Choice Chapter: 22 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 378, Antipsychotic/Neuroleptic Drugs 13. The nurse is providing teaching about an antipsychotic newly prescribed for the client. The nurse cautions the client against actions that may cause increased central nervous system (CNS) depression. What should the nurse caution the client against? A) maintaining an inconsistent sleep schedule B) consumption of alcohol C) use of over-the-counter NSAIDs D) tobacco use

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Ans: B

Feedback: Antipsychotic–alcohol combinations result in an increased risk of CNS depression. NSAIDs, tobacco, and variable sleep schedules do not directly lead to CNS depression.

Format: Multiple Choice Chapter: 22 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 384, Nursing Considerations for Patients Receiving Antipsychotic/Neuroleptic Drugs 14. The nurse on a psychiatric unit contributes to the care of many clients, most of whom have physical as well as psychiatric health problems. For which client would clozapine most likely be contraindicated? A) an 18-year-old adolescent B) a 23-year-old client with diabetes mellitus C) a 32-year-old client with osteoarthritis D) a 45-year-old client with bone marrow suppression

Ans: D

Feedback: Clozapine an antipsychotic drug is associated with bone marrow suppression, a life-threatening decrease in white blood cells. Because of their wide-ranging adverse effects, antipsychotic drugs may cause or aggravate various conditions. They should be used very cautiously in clients with liver damage, coronary artery disease, cerebrovascular disease, parkinsonism, bone marrow depression, severe hypotension or

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hypertension, coma, or severely depressed states. Diabetes, osteoarthritis, and an age of 18 would not contraindicate its use.

Format: Multiple Choice Chapter: 22 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 377, Mental Disorders and Their Classification 15. Parents bring a 15-year-old client into the clinic. The parents tell the nurse that there is a family history of schizophrenia, and they fear their child has developed the disease. What symptoms, if described by the family, would support their conclusion? A) “Our child hears and interacts with voices no one else can hear.” B) “Our child is overactive and always so excitable.” C) “Our child falls asleep in the middle of a sentence.” D) “Our child cannot concentrate and their grades are suffering.”

Ans: A

Feedback: Characteristics of schizophrenia include hallucinations, paranoia, delusions, speech abnormalities, and affective problems. Overactivity and excitement are associated with mania. Falling asleep suddenly describes narcolepsy. Difficulty concentrating and failing grades is associated with attention deficit disorders.

Format: Multiple Choice Chapter: 22 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 378, Antipsychotic/Neuroleptic Drugs 16. A resident of a long-term care facility is experiencing insomnia since being transferred to the facility. What antipsychotic would best help this client sleep? A) trifluoperazine B) aripiprazole C) paliperidone D) quetiapine

Ans: D

Feedback: Quetiapine has a significant sedative effect, more so than any of the other listed medications.

Format: Multiple Choice Chapter: 22 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 393, Box 22.5 Focus on The Evidence: School Nursing and CNS Stimulant Administration 17. What is the school nurse’s primary responsibility regarding a student being medically treated for a diagnosis of attention deficient-hyperactive disorder (ADHD)? A) administrating midday medication dose B) contributing to the child’s comprehensive treatment plan C) providing medication education to parents and care providers D) evaluating the child’s ability to effectively learn appropriately

Ans: B

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Feedback: At first, the medications needed to be dosed multiple times per day, so school nurses were often required to administer the midday dose to the child. However, there are many longer-acting formulations available now. Both amphetamine and methylphenidate have multiple formulations that are dosed differently. The school nurse may not need to administer the medication, but they would need to be able to be a part of the comprehensive treatment plan for the student. The nurse is responsible for education educators but not necessarily the child’s parents or caregivers. The teacher is responsible for evaluating the child’s learning ability and appropriate progression academically.

Format: Fill-in-the-Blank Chapter: 22 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 378, Antipsychotic/Neuroleptic Drugs 18. A 12-year-old client with a history of psychosis has been prescribed thioridazine PO in three divided doses. The client weighs 110 lb. The nurse consults the drug guide and confirms that this medication is approved for pediatric use at up to 3 mg/kg/d PO. What is this client’s maximum safe individual dose? Record your answer as a whole number.

Ans: 50 mg

Feedback: The client’s weight must be converted to kilograms by dividing the weight in pounds by 2.2. This gives a weight of 50 kg. The maximum daily dose is 3 mg/kg/d, and 3 mg × 50 kg = 150 mg per day. Dividing 150 mg by 3 yields the maximum individual dose, since it is given t.i.d.

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Format: Multiple Selection Chapter: 22 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 378, Antipsychotic/Neuroleptic Drugs 19. The nurse is caring for a client who has been newly diagnosed with schizophrenia and whose medical history requires a typical antipsychotic. When explaining possible anticholinergic effects to the client, the nurse should address what potential problem(s) related to these effects? Select all that apply. A) gum ulceration B) constipation C) urinary retention D) blurred vision E) ringing in the ears

Ans: A, B, C, D

Feedback: Anticholinergic effects include dry mouth (which can cause gum ulceration), constipation, urinary retention, and decreased visual accommodation (causing blurred vision). Tinnitus is not an anticholinergic effect.

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20. A 7-year-old child is admitted to the emergency department with a diagnosis of an acute psychotic episode. Aripiprazole has been prescribed. Before administering the medication, what is the nurse’s first priority? A) Weigh the client. B) Obtain baseline vital signs. C) Confirm the order with the prescriber D) Establish IV access

Ans: C

Feedback: Of the antipsychotics, chlorpromazine, haloperidol, pimozide, prochlorperazine, risperidone, thioridazine, and trifluoperazine are the only ones with established pediatric regimens. Aripiprazole has dosages for children 13 to 17 years of age but would not be appropriate for a 7-year-old child. Weighing the client and obtaining baseline vital signs are necessary assessment data but are not the first priority. Clarifying the order is a priority over IV access.

Format: Multiple Choice Chapter: 22 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Difficulty: Easy Integrated Process: Communication and Documentation Objective: 1, 5 Page and Header: 377, Mental Disorders and Their Classification 21. The nurse admits a client who has been newly diagnosed with schizophrenia to the inpatient mental health unit. What is the priority reason for why the nurse includes the family when collecting the nursing history? A) The client may not be able to provide a sufficient history. B) The client may have a reduced level of consciousness. C) The family will feel empowered by being included in the process. D) The client will be less anxious if the family listens while the client answer questions.

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Ans: A

Feedback: Schizophrenia, the most common psychosis, is characterized by delusions, hallucinations, and inappropriate responses to stimuli. As a result, the client may be unable to provide a coherent history and may be unaware of their behaviors considered dysfunctional. There is no reason to suspect the client cannot speak, and reducing anxiety is not the priority rationale for including family. While family is included in treatment, the goal is to treat the client and not make the family feel better if actions were not in the client’s best interests.

Format: Multiple Choice Chapter: 22 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 386, Patient Teaching for B.A. 22. The nurse is providing discharge teaching to a client who has been recently diagnosed with schizophrenia. What is a priority teaching point for this client? A) The client must eat three nutritious meals daily. B) Over-the-counter medications should be used within the recommended doses. C) Cough medicines potentiate the actions of antipsychotic drugs. D) Alcohol consumption should be avoided.

Ans: D

Feedback: Alcohol consumption should be avoided because it increases the central nervous system (CNS) effects of the drug and may cause excessive drowsiness and decreased awareness of safety hazards in the environment. Some clients may find it easier and more effective to eat five small meals rather than three nutritious meals.

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While promoting good nutrition is good practice, it is not the priority. Drug–drug interactions with antipsychotic drugs are common so the nurse would teach the client not to take any medication without consulting with the health care provider or a pharmacist to make sure it is safe.

Format: Multiple Choice Chapter: 22 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 389, Nursing Considerations for Patients Receiving Lithium 23. The nurse is caring for a client who has been diagnosed with bipolar disorder and whose medication regimen includes lithium. What health education should the nurse prioritize when preparing the client for discharge? A) strategies for managing anticholinergic effects B) the need to avoid driving or operating machinery during therapy C) the need to have follow-up blood samples drawn on schedule D) the need to avoid high-potassium foods and salt substitutes

Ans: C

Feedback: Serum levels of lithium must be carefully monitored to ensure effectiveness and prevent toxicity. The need for blood work is consequently a priority. The client does not necessarily have to avoid driving, and there is no need to strictly avoid potassium. Lithium does not cause anticholinergic effects.

Format: Multiple Selection Chapter: 22 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 378, Antipsychotic/Neuroleptic Drugs 24. A 79-year-old client has been diagnosed with dementia. Haloperidol has been ordered for this client to help manage their worsening agitation. What nursing consideration(s) should inform the nurse’s administration of this medication? Select all that apply. A) It is classed as an atypical antipsychotic. B) Is associated with prolonging the QTc interval. C) Carries a risk for the development of diabetes mellitus D) It should not be used to control behavior with dementia. E) It should only be given every other day.

Ans: B, D

Feedback: Haloperidol a typical antipsychotic medication has been shown to prolong the QTc interval, leading to increased risk of serious cardiac arrhythmias, so QTc may need to be monitored in at-risk clients. Antipsychotics are contraindicated for use in older adult clients with dementia because this use is associated with an increased risk of cardiovascular (CV) events and death. Haloperidol is generally ordered t.i.d. All of the atypical antipsychotics include warnings that there is a risk for the development of diabetes mellitus and weight gain

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Page and Header: 390, Drugs for Attention Deficit Hyperactivity Disorder and Narcolepsy 25. A recent nursing graduate is having difficulty adjusting to shift work and has been prescribed armodafinil. When should the nurse take this medication? A) as soon as a shift ends B) one hour before the start of a shift C) at the same time every day D) when severe fatigue is experienced Ans: B

Feedback: Armodafinil is taken 1-hour before a shift to enhance wakefulness.

Format: Multiple Choice Chapter: 22 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 390, Drugs for Attention Deficit Hyperactivity Disorder and Narcolepsy 26. The parents of a child diagnosed with attention-deficit hyperactivity disorder (ADHD) receives a prescription for a central nervous system (CNS) stimulant to treat their child. One of the parents asks the nurse, “I don’t understand why we’re giving a stimulant to calm our child down?” What is the nurse’s best response? A) “It helps the reticular activating system, a part of the brain, to be more selective in response to incoming stimuli.” B) “It helps energize the child so they use up all of their available energy and then they can focus on quieter stimuli.” C) “No one truly understands why it works, but it has been demonstrated to be very effective in treating attention-deficit.” D) “The drugs work really well and you will see a tremendous change in your child within a few weeks without any other treatment.”

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Ans: A

Feedback: The paradoxical effect of calming hyperexcitability through CNS stimulation seen in attention-deficit syndrome is believed to be related to increased stimulation of an immature RAS, which leads to the ability to be more selective in response to incoming stimuli. CNS stimulants do not cause the child to use all their energy, the effect is thought to be understood, and telling the parents the drug just works without any explanation is not appropriate and may result in noncompliance with pharmacology therapy if the parents do not understand why the drug is given.

Format: Multiple Choice Chapter: 22 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 392, Nursing Considerations for Patients Receiving Central Nervous System Stimulants 27. A child was diagnosed with attention-deficit hyperactivity disorder (ADHD), and methylphenidate was prescribed for treatment to be taken once a day in a sustainedrelease form. On future visits, what is a priority nursing assessment for this child? A) weight and height B) breath sounds and respiratory rate C) urine output and kidney function D) electrocardiogram (ECG) and echocardiogram

Ans: A

Feedback: The nurse needs to carefully track this child’s weight and height because the drug can cause weight loss, anorexia, and nausea that could result in slowed or absent growth. There would be no need to monitor breath sounds, respiratory rate, urine

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output, and kidney function. Although arrhythmias may occur as an adverse effect necessitating an ECG, there is no need to perform echocardiograms. Format: Multiple Choice Chapter: 22 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 392, Nursing Considerations for Patients Receiving Central Nervous System Stimulants 28. The nurse is preparing to administer methylphenidate to the child admitted to the pediatric unit after breaking a leg longboarding. Where should the nurse find the medication? A) in the client’s drawer B) in the refrigerator C) at the client’s bedside D) in the controlled substance cabinet

Ans: D

Feedback: Methylphenidate is a controlled medication due to risk for physical and psychological dependence. As a result, the drug would be found in the controlled substance cabinet. It does not require refrigeration.

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Page and Header: 390, Drugs for Attention Deficit Hyperactivity Disorder and Narcolepsy 29. The nurse is caring for a child receiving a central nervous system (CNS) stimulant who was admitted to the pediatric intensive care unit following repeated seizures after a closed head injury. The provider orders phenytoin to control seizures and lorazepam to be administered every time the child has a seizure. What is the nurse’s priority action? A) Call the provider and question the administration of phenytoin. B) Call the provider and question the administration of lorazepam. C) Wait 24 hours before beginning to administer phenytoin. D) Wait 24 hours before beginning to administer lorazepam.

Ans: A

Feedback: The combination of CNS stimulants with phenytoin leads to a risk of increased drug levels. Clients who receive such a combination should be monitored for toxicity. There is no contraindication for use of lorazepam.

Test Generator Questions, Chapter 23, Antiseizure Agents Format: Multiple Choice Chapter: 23 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 404, Barbiturates and Barbituratelike Drugs 1. A client is admitted to the emergency department with severe recurrent convulsive seizures. What drug should the nurse expect to be ordered for use in emergency control of status epilepticus? A) pregabalin B) valproic acid C) phenobarbital

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D) gabapentin

Ans: C

Feedback: Phenobarbital is used for emergency control of status epilepticus. Gabapentin, pregabalin, and valproic acid are used for treatment of partial seizures.

Format: Multiple Choice Chapter: 23 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 408, Other Medications That Are Used to Treat Generalized Seizures 2. A client with a recent history of seizures has been prescribed carbamazepine. The nurse should recognize that this medication will achieve a therapeutic effect by what means? A) reducing electrical activity in the thalamus and hypothalamus B) altering the permeability of neuron cell membranes C) affecting gamma-aminobutyric acid (GABA) levels and blocking sodium channels D) depressing conduction in the brainstem and cortex and slowing the reuptake of dopamine

Ans: C

Feedback: Carbamazepine affects GABA activity and inhibits sodium channels to stop action potentials. Succinimides reduce electrical activity. Acetazolamides reduce electrical activity and alter sodium and calcium channels. Barbiturates depress conduction in the brainstem and the cortex but do not affect dopamine reuptake.

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Format: Multiple Choice Chapter: 23 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 398, Nature of Seizures 3. A school-aged child is brought to the clinic by their parents. The parents state that the child will be engaged in some activity at home and then will just stop suddenly for a few seconds and then pick up the activity again as if there had been no break in what the child was doing. This child should be assessed for what neurological disorder? A) tonic–clonic seizures B) absence seizures C) myoclonic seizures D) status epilepticus

Ans: B

Feedback: Absence seizures involve abrupt periods of loss of consciousness lasting 3 to 5 seconds. Tonic–clonic seizures involve dramatic muscle contractions, loss of consciousness, and a recovery period characterized by confusion and exhaustion. Myoclonic seizures involve short, sporadic periods of muscle contractions lasting for several minutes. These types of seizures are rare. Status epilepticus seizures are the most dangerous and rapidly occur one after another.

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Objective: 2, 5 Page and Header: 404, Barbiturates and Barbituratelike Drugs 4. A client is brought into the emergency department in status epilepticus, and the nurse is administering phenobarbital 300 mg IV as prescribed. Family members ask the nurse how long it will take to stop the seizures. What is the nurse’s best response? A) “The seizures will probably stop in around 5 minutes.” B) “We should see results in 10 to 30 minutes.” C) “It will take at least 30 minutes before the seizures begin to subside.” D) “It may be an hour, or slightly more, before the seizures stop.”

Ans: B

Feedback: The onset of IV phenobarbital is 5 minutes; however, it is important not to confuse when the onset of action will occur and when the seizures will stop because additional interventions may be needed to stop the seizure activity in some cases. For intramuscular and subcutaneous administration, the onset should be between 10 and 30 minutes. Onset for an oral dose is between 30 and 60 minutes.

Format: Multiple Choice Chapter: 23 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 401, Hydantoins 5. The nurse evaluates the client’s latest serum phenytoin level which is revealed to be 16 mcg/mL. What is the nurse’s best action? A) Contact the provider to discuss the need for a supplementary dose of phenytoin. B) Document the fact that the client’s phenytoin level is therapeutic. C) Promptly establish seizure precautions. D) Contact the provider to discuss withholding the next scheduled dose.

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Ans: B

Feedback: The therapeutic serum level range for phenytoin is between 10 and 20 mcg/mL. As such, there is no need to contact the provider. Seizure precautions are likely already in place, and if they are not, this laboratory result does not provide an indication for reinstituting them. Format: Multiple Choice Chapter: 23 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 401, Hydantoins 6. A school-aged child has been diagnosed with a seizure disorder and phenytoin has been prescribed. What nursing diagnosis would be most appropriate if the child demonstrated adverse effects to the drug related to cellular toxicity? A) deficient fluid volume related to diuresis B) impaired skin integrity related to dermatological effects C) noncompliance to drug therapy related to avoidance of adverse effects D) insomnia related to CNS stimulation

Ans: B

Feedback: Impaired skin integrity related to dermatological effects would be appropriate because phenytoin can cause potentially serious dermatological effects. This is related to cellular toxicity. Usually this drug will cause the client to be sleepy all day and should enhance sleep at night. Deficient fluid volume is not a concern with this drug. Noncompliance will probably not be an issue at this age because the parents and school nurse will administer the medication.

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Format: Multiple Choice Chapter: 23 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 408, Other Medications That Are Used to Treat Generalized Seizures 7. A client’s seizure activity, which is isolated to facial and neck muscles, has been identified as being caused by one area of the client’s brain. The nurse should anticipate the administration of what drug? A) carbamazepine B) clorazepate C) felbamate D) gabapentin

Ans: A

Feedback: Carbamazepine is often the drug of choice for treatment of partial seizures, which are described in this scenario. It has the ability to inhibit polysynaptic responses and to block sodium channels to prevent the formation of repetitive action potentials in the abnormal focus. Clorazepate is indicated for anxiety and alcohol withdrawal and used as adjunctive therapy for partial seizures. Felbamate has been associated with severe liver failure and aplastic anemia and is now reserved for those clients who do not respond to other therapies. Gabapentin is used as adjunctive therapy in the treatment of partial seizures and for the treatment of postherpetic neuralgia.

Format: Multiple Choice Chapter: 23 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 2 Page and Header: 408, Other Medications That Are Used to Treat Generalized Seizures 8. A client with a history of partial seizures has been taking lamotrigine for the past several days. The client calls the clinic and reports the development of a facial and torso rash to the nurse. What is the nurse’s best action? A) Rule out any shortness of breath and inform the client that this adverse effect will resolve with time. B) Recommend that the client take 50 mg diphenhydramine PO and check back tomorrow. C) Tell the client to take the medication with a high-fat food to minimize adverse effects. D) Tell the client to take no further doses and come be assessed at the clinic immediately.

Ans: D

Feedback: The nurse should inform the client to discontinue the drug and return to the clinic. Rashes associated with the use of lamotrigine can be life threatening. The client needs to return to the clinic to be evaluated and will need a change of medication. Recommending another medication is insufficient and is also beyond the nurse’s scope. High-fat foods are of no benefit.

Format: Multiple Choice Chapter: 23 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 398, Nature of Seizures 9. Which client should the nurse identify as having an absence seizure? A) A client whose alterations in consciousness last a few seconds.

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B) A client who occasionally has automatic and repetitive movements over 1 to 2 minutes. C) A client who has abnormal movements and bizarre behavior during a time of stress. D) A child exhibits sustained and rhythmic contraction of skeletal muscle.

Ans: A

Feedback: Absence seizures are characterized by abrupt alterations in consciousness that last only a few seconds. Characteristics of an absence seizure do not include automatic and repetitive movements, abnormal movements and bizarre behavior, or sustained contraction of skeletal muscle.

Format: Multiple Choice Chapter: 23 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 401, Hydantoins 10. The nurse is providing client education for a client who has been newly prescribed a hydantoin antiseizure medication. The nurse has taught the client about the need to taper down the dose of the drug slowly when the provider decides it should be discontinued. What benefit of tapering should the nurse describe? A) shorter duration of absence seizures B) reduced risk of cardiac dysrhythmias C) improved blood pressure stability D) reduced risk of status epilepticus Ans: D

Feedback: Discontinuing hydantoins could result in status epilepticus so that drugs should be withdrawn, or added to the medication regimen, carefully to avoid danger. An

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abrupt withdrawal of antiseizure medications would not precipitate hypertensive crisis, dysrhythmias. The actual duration of absence seizures would not be affected.

Format: Multiple Choice Chapter: 23 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 405, Benzodiazepines 11. A client is brought to the emergency department in the midst of acute alcohol withdrawal accompanied by seizure activity. What drug is most likely to meet this client’s needs? A) diazepam B) phenytoin C) ethosuximide D) gabapentin

Ans: A

Feedback: The drug of choice for acute alcohol withdrawal and related seizures is intravenous benzodiazepine, usually diazepam. Phenytoin is administered to control and prevent seizures but is not the drug of choice to stop an active seizure. Gabapentin and ethosuximide are administered for the treatment of alcohol withdrawal. Format: Multiple Choice Chapter: 23 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2

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Page and Header: 406, Succinimides 12. The nurse is caring for a client who is receiving ethosuximide to control absence seizure activity. When reviewing the client’s laboratory results, the nurse learns that the client’s serum ethotoin level is 108 mcg/mL. What is the nurse’s best action? A) Administer naloxone as prescribed. B) Report this finding to the provider and monitor closely for seizure activity. C) Report this to the provider and monitor for signs of toxicity. D) Document the fact that the client’s ethotoin levels are therapeutic.

Ans: C

Feedback: Therapeutic serum ethosuximide levels range between 40 and 100 mcg/mL. A level of 108 mcg/mL would raise the possibility of toxicity, not seizure. This should be documented but also reported to the provider. Naloxone is only indicated for opioid overdoses.

Format: Multiple Choice Chapter: 23 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 1, 5 Page and Header: 400, Generalized Seizures 13. The nurse, working in the emergency room, admits an 18-month-old toddler with influenza symptoms reported by the parents to have had a seizure. Further questioning of the parents indicates that the toddler likely had a clonic–tonic seizure, which has never happened before. What is the nurse’s priority action? A) Monitor serum phenytoin level. B) Take the child’s temperature. C) Place the child in a tepid bath. D) Administer an antipyretic medication as prescribed.

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Ans: B

Feedback: The first action of the nurse is to measure body temperature to determine whether the child has a fever, which could explain why the seizure occurred. Febrile seizures are common in young children. They are related to very high fevers and usually involve clonic–tonic seizure. Febrile seizures most frequently occur in children, and they are usually self-limited and do not reappear. The nurse would not treat a fever by administering antipyretics or providing a tepid bath until temperature is measured. There would be no reason to check phenytoin levels if the child has no history of seizure disorder.

Format: Multiple Choice Chapter: 23 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 401, Hydantoins 14. An 11-year-old client has been diagnosed with epilepsy and prescribed phenytoin 100 mg PO b.i.d. What statement by the client’s parent suggests an accurate understanding of the client’s medication regimen? A) “I will make sure my child takes the medication on an empty stomach.” B) “I will stop the drug immediately if any side effects occur.” C) “I will make sure my child has routine visits to the dentist.” D) “I will weigh my child daily and feed them a high-calorie diet.”

Ans: C

Feedback: Gingival hyperplasia is common in clients, especially children, who take phenytoin, which makes regular dentist visits important to oral health. Taking the

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medication on a full stomach or with meals reduces gastrointestinal (GI) adverse effects. The parent should call the health care provider if adverse effects are noted and needs to understand the risks associated with abrupt withdrawal of the medication. Daily weight taking and high-calorie diets are not necessary during phenytoin administration.

Format: Multiple Choice Chapter: 23 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Moderate Integrated Process: Caring Objective: 5 Page and Header: 410, Critical Thinking Scenario: Antiepileptic Drugs 15. A 21-year-old client is distraught about the implications of their recent diagnosis of seizure activity. When addressing this client’s most likely psychosocial needs, what topic should the nurse address? A) the consequences of quitting college B) loss of libido and sexual performance C) the client’s loss of their driver’s license D) the consequences of needing bed rest during stressful times

Ans: C

Feedback: The client is likely to lose their driver’s license, which for many clients has serious and varied implications. However, the client will not likely need to quit college or have frequent times of bed rest. Sexual activity is less likely to be impacted than mobility.

Format: Multiple Selection Chapter: 23 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 401, Hydantoins 16. The client’s serum levels of phenytoin have been above therapeutic limits several times in the past few months. The nurse should perform what assessments? Select all that apply. A) reviewing the client’s liver enzyme levels B) reviewing the client’s levels of formed blood components C) assessing the client’s integumentary system D) auscultating the client’s lung E) assessing the client’s blood pressure

Ans: A, B, C, E

Feedback: Toxic levels of phenytoin increase the likelihood of adverse effects so the nurse would assess for liver toxicity, bone marrow suppression, or serious dermatological reactions. Changes in blood pressure are also possible. Respiratory complications are not associated with phenytoin.

Format: Multiple Choice Chapter: 23 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 406, Succinimides 17. A client has been newly diagnosed with seizure disorder. What aspect of this client’s health status would contraindicate the use of ethosuximide? A) The client’s most recent blood work reveals pancytopenia.

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B) The client has type 2 diabetes, controlled through diet. C) The client has an allergy to sulfonamides. D) The client is 17 years old.

Ans: A

Feedback: Bone marrow suppression would be considered a contraindication to administration of ethosuximide therapy. Contraindications to the use of this drug do not include an allergy to sulfonamides or diabetes. The drug could be safely administered to a 17-year-old client.

Format: Multiple Choice Chapter: 23 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 408, Other Medications That Are Used to Treat Generalized Seizures 18. A client diagnosed with liver cirrhosis and hepatitis C needs an antiepileptic drug. What drug would be safest for this client? A) levetiracetam B) lamotrigine C) phenobarbital D) valproic acid

Ans: A

Feedback: Levetiracetam is excreted by the kidneys and is not metabolized by the liver so it would be safer for the client diagnosed with liver disease. The other options are all metabolized by the liver, so the client with liver disease will need a lower dosage.

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Format: Multiple Selection Chapter: 23 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 401, Drugs for Treating Generalized Seizures 19. The nurse is caring for a client who has been diagnosed with generalized seizures and will appropriately administer what classification(s) of medications to this client? Select all that apply. A) succinimides B) acetazolamide C) valproic acid D) hydantoins E) benzodiazepines

Ans: A, D, E

Feedback: Various drugs are used to treat generalized seizures, including hydantoins, barbiturates, barbituratelike drugs, benzodiazepines, and succinimides.

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20. The nurse is caring for a 4-year-old child who has been diagnosed with a seizure disorder requiring an antiseizure agent (oxcarbazepine). What principle should guide the care team’s medication management? A) Benzodiazepines are the only approved antiseizure drugs for children. B) Children often require a larger milligram per kilogram dose than an adult. C) Children often receive adult doses determined by their weight. D) Electroconvulsive therapy is considered safer and more effective than drug therapy.

Ans: B

Feedback: Children’s dosing of medications are often specific to age and weight. Older children (2 months to 6 years of age) absorb and metabolize many of these drugs more quickly than adults and require a larger dosage per kilogram to maintain therapeutic levels. This does not, however, mean they receive the same actual dose as an adult. There are multiple drug options for treating childhood seizures. Electroconvulsive therapy is not indicated.

Format: Multiple Selection Chapter: 23 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 397, Introduction 21. The nurse is working with the interdisciplinary team to plan the care of a client who has been newly diagnosed with epilepsy. What factor(s) should the team consider when determining the drug of choice for the client? Select all that apply. A) age B) type of epilepsy C) cognitive status D) culture and ethnicity

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E) gender

Ans: A, B, D

Feedback: The drug of choice for any given situation depends on the type of epilepsy, client age, specific client characteristics such as cultural variations, and client tolerance for associated adverse effects as opposed to preferred adverse effect. Gender and cognition do not play a role in determining drug of choice.

Ans: B

Feedback: Because of differences in liver enzyme functioning among Asian Americans, clients in these ethnic groups may not metabolize antiseizure agents in the same way as clients in other ethnic groups. They may require not only lower doses to achieve the same therapeutic effects but also frequent dose adjustment. Nothing indicates a need to alter dosage for clients of African Arab, or Native American descent.

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Format: Multiple Selection Chapter: 23 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 409, Nursing Considerations for Patients Receiving Drugs for Treating Generalized Seizures 23. A client diagnosed with a seizure disorder has had a recent change in medication. What assessment(s) should the nurse perform in order to evaluate the effectiveness of the new drug? Select all that apply. A) Evaluate the client’s bowel pattern. B) Evaluate laboratory drug level. C) Assess for adverse effects. D) Assess for change in seizure activity. E) Assess for changes in mood.

Ans: B, C, D

Feedback: The nurse should interview and assess for any change in seizure activity; interview and assess for avoidance of adverse drug effects, especially those that impair safety; when available, check laboratory reports of serum drug levels for therapeutic ranges or evidence of underdosing or overdosing. Mood and bowel pattern are unlikely to be affected, and neither parameter suggests success or failure of treatment.

Format: Multiple Choice Chapter: 23 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 397, Introduction 24. A client is brought in to the emergency department by ambulance in status epilepticus. What drug would best halt this client’s seizure activity? A) carbamazepine B) clorazepate C) ethotoin D) fosphenytoin

Ans: D

Feedback: Only fosphenytoin is indicated for the treatment of status epilepticus. Carbamazepine is used to treat seizure disorders as well as trigeminal neuralgia and bipolar disorder, but it is not indicated for status epilepticus. Clorazepate and ethotoin are used in long-term treatment of partial seizure disorders, alone, or with other antiepileptic drugs but would not be used for status epilepticus.

Format: Multiple Choice Chapter: 23 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 409, Nursing Considerations for Patients Receiving Drugs for Treating Generalized Seizures 25. A client has been prescribed phenytoin for the treatment of seizures. How should the nurse most accurately determine whether the client has therapeutic levels of the medication? A) Review the client’s laboratory blood work. B) Assess the client carefully for adverse effects.

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C) Monitor the client for seizure activity. D) Assess the client’s cognitive status.

Ans: A Feedback: Measuring serum drug levels evaluates whether the therapeutic range of circulating drug can be found in the serum. It does not directly evaluate effectiveness of therapy, however, which can only be evaluated by determining whether the drug is having the desired effect of reducing number of seizures. Short-term absence of seizures does not necessarily indicate that drug is within therapeutic range.

Format: Multiple Choice Chapter: 23 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 4 Page and Header: 405, Benzodiazepines 26. The provider believes that a client diagnosed with absence seizures would benefit from the administration of ethosuximide or methsuximide. On what basis would ethosuximide be most likely preferred? A) Ethosuximide does not require weekly laboratory blood work. B) Ethosuximide can be administered orally, while methsuximide is administered IV only. C) Methsuximide is exponentially more expensive than ethosuximide. D) Methsuximide has more severe adverse effects than ethosuximide.

Ans: D

Feedback: Ethosuximide and methsuximide are indicated for the control of absence seizures. Ethosuximide should be tried first; methsuximide should be reserved for the treatment of seizures that are refractory to other agents because it is associated with

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more severe adverse effects. There are no appreciable differences in cost or the need for blood work. Both are administered orally. Format: Multiple Choice Chapter: 23 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 407, Drugs That Modulate the Inhibitory Neurotransmitter GABA 27. A client newly diagnosed with a seizure disorder has been prescribed valproic acid. When assessing for adverse effects, what assessment should the nurse prioritize? A) monitoring the client’s liver enzyme levels B) assessing the client for signs of respiratory distress C) assessing the client’s apical heart rate and rhythm D) performing musculoskeletal assessment

Ans: A

Feedback: Valproic acid is associated with liver toxicity, so the nurse should periodically check the client’s liver enzyme levels. Respiratory distress, cardiac damage, and muscle weakness are not associated with valproic acid therapy.

Format: Multiple Choice Chapter: 23 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 409, Nursing Considerations for Patients Receiving Drugs for Treating Generalized Seizures

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28. While writing a care plan for a client newly diagnosed with generalized seizures, the nurse might appropriately choose what nursing diagnosis? A) risk for injury related to gastrointestinal (GI) effects B) altered thought processes related to central nervous system effects C) decreased cardiac output related to autonomic disruption D) chronic confusion related to central nervous system depression

Ans: B

Feedback: Altered thought processes related to central nervous system (CNS) effects is a nursing diagnosis for a client receiving any antiepileptic medication for generalized seizures. Risk for injury is incorrect because the risk for injury to this client is due to the CNS effects, not GI effects. Cardiac output is not normally affected, and CNS depression does not cause chronic confusion.

Format: Multiple Choice Chapter: 23 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 409, Nursing Considerations for Patients Receiving Drugs for Treating Generalized Seizures 29. The client newly diagnosed with epilepsy begins to show signs of seizure activity. What is the nurse’s priority action? A) Obtain the client’s vital signs as soon as possible. B) Attempt to calm the client. C) Protect the client’s safety. D) Perform detailed documentation.

Ans: C

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Feedback: As in any nursing situation, safety is paramount. The client’s safety is prioritized over documentation or gathering vital signs. Seizure activity cannot be influenced by calming a client.

Format: Multiple Selection Chapter: 23 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 397, Introduction 30. The nurse is caring for an 84-year-old client in the acute care facility who was newly diagnosed with a seizure disorder. Before starting the client on an antiepileptic medication that will be continued after discharge, what laboratory studies should the nurse assess? Select all that apply. A) serum drug levels B) liver function studies C) renal function studies D) cardiovascular function studies E) central nervous system function studies

Ans: B, C

Feedback: Baseline kidney and liver function tests should be done, and results will guide dosing of the antiepileptic medication because clients with liver or kidney disease will require lower dosages of medication. Serum drug levels will not be drawn until after specific medications are started. Cardiovascular and central nervous system function studies are not indicated. Format: Multiple Choice Chapter: 23

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Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 1 Page and Header: 398, Nature of Seizures 31. The client has a seizure that causes rhythmic twitching of the left hand for 90 seconds with no loss of consciousness and then stops. The nurse notes this same action repeated many times throughout the day and documents this as what type of seizure? A) myoclonic seizure B) jacksonian seizure C) psychomotor seizure D) focal seizure

Ans: D

Feedback: This client is having partial focal seizures, which occur in a single area of the brain and may involve a single muscle movement or sensory alteration but does not spread over the entire body. Myoclonic seizures involve short, sporadic periods of muscle contractions that last for several minutes. Jacksonian seizures begin in one area of the brain and involve one part of the body and then progressively spread to other parts of the body; they can develop into generalized tonic–clonic seizures. Psychomotor seizures are complex seizures that involve sensory, motor, and psychic components.

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32. A client has been administered phenobarbital during seizure activity. When assessing for adverse effects after resolution of the seizure, what assessment should the nurse prioritize? A) assessment of orientation B) evaluation of deep tendon reflexes C) assessment for tetany D) focused respiratory assessment

Ans: A

Feedback: The most common adverse effects associated with barbiturates relate to CNS depression and its effects on body function. As a result, cognition would be a central focus. Tetany is related to disruptions in calcium levels, so would be unlikely. Respiratory function and reflexes are not commonly affected.

Format: Multiple Selection Chapter: 23 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 408, Other Medications That Are Used to Treat Generalized Seizures; 399, Box 23.3 Focus on Cultural Considerations: Antiseizure Agents and Genetic Differences 33. The nurse is caring for an older client of Asian descent. The client has a history of heart failure and has now been prescribed carbamazepine. The nurse should monitor this client closely for what serious adverse effect? Select all that apply. A) epidermal necrolysis B) thrombocytopenia C) peptic ulcers D) Steven–Johnson syndrome

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E) fluid overload

Ans: A, D

Feedback: A genetic risk factor associated with serious dermatologic reactions has been identified with some of the antiseizure agents. Having the inherited allele variant of the HLA-B gene, HLA-B*1502, has been shown to increase risk of developing toxic epidermal necrolysis and Steven–Johnson syndrome in people taking carbamazepine. This allele has been demonstrated more strongly in clients of Asian descent. While carbamazepine can cause CNS effects, including blood dyscrasias (leukopenia, anemia, and thrombocytopenia), edema, HTN, and fluid overload, especially in clients with heart failure, people of Asian descent have no greater risk than the general population.

Format: Multiple Choice Chapter: 23 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 404, Box 23.5 Focus on Herbal and Alternative Therapies 34. What herbal supplement should a client being treated for tonic–clonic seizures with phenytoin specifically avoid? A) evening primrose B) ginger C) ginkgo D) feverfew

Ans: C

Feedback: Clients being treated with divalproex or phenytoin should be advised not to use ginkgo because it may lower the medication’s effectiveness. Clients being treated for

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epilepsy should be advised not to use the herb evening primrose because it increases the risk of having seizures. Neither of the other options are known to affect phenytoin’s effectiveness.

Test Generator Questions, Chapter 24, Antiparkinsonism Agents Format: Multiple Choice Chapter: 24 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 419, Pathophysiology 1. The nurse is caring for a client who has been diagnosed with Parkinson’s disease. What should the nurse anticipate for this client? A) excessive gamma-aminobutyric acid (GABA) levels B) hypoxia in the corpus striatum C) deficient levels of dopamine D) hypertrophy of the substantia nigra

Ans: C

Feedback: Degeneration of dopamine-releasing neurons in the substantia nigra leads to Parkinson’s disease. When dopamine is decreased in the area of the corpus striatum, a chemical imbalance allows the cholinergic or excitatory cells to dominate. The pathophysiology of the disease does not involve brain hypoxia, hypertrophy, or high levels of GABA.

Format: Multiple Choice Chapter: 24

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 421, Box 24.1 Focus on Drug Therapy across the Lifespan 2. A 10-year-old client has been prescribed an antiparkinsonian drug due to changes in movement. Which treatment should the nurse expect as the first choice for this child? A) benztropine B) diphenhydramine C) trihexyphenidyl D) electroconvulsive therapy (ECT)

Ans: B

Feedback: Parkinson’s disease is rare in children. However, if a child needs an antiparkinsonian drug, diphenhydramine is the drug of choice. Benztropine and trihexyphenidyl are not recommended for use in children. ECT would not be used to treat a movement disorder in a child.

Format: Multiple Selection Chapter: 24 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 426, Anticholinergic Agents 3. A client is newly diagnosed with Parkinson’s disease. What aspect(s) of this client’s health history rules out the safe and effective use of an anticholinergic drug? Select all that apply. A) benign prostatic hypertrophy

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B) macular degeneration C) chronic bowel obstructions D) atrial fibrillation E) psoriasis

Ans: A, C

Feedback: Anticholinergics are contraindicated in the presence of narrow-angle glaucoma, GI obstruction, genitourinary (GU) obstruction, and prostatic hypertrophy, all of which could be exacerbated by the peripheral anticholinergic effects of these drugs. Atrial fibrillation would necessitate cautious use. Macular degeneration and psoriasis would not affect the choice of drug.

Format: Multiple Choice Chapter: 24 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 421, Box 24.1 Focus on Drug Therapy across the Lifespan 4. A client is newly diagnosed with Parkinson’s disease, and levodopa has been prescribed. What health education should the nurse provide? A) identifying foods and supplements high in vitamin B6 B) the need for weekly laboratory blood work for the first 6 weeks C) the fact that adverse effects will subside when the body adjusts to the drug D) matching doses to the daily severity of symptoms

Ans: A

Feedback: The priority information would be to avoid vitamin B6 intake, which would include grains and bran. Vitamin B6 speeds the conversion of levodopa to dopamine

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before it can cross the blood–brain barrier. This leads to Parkinson’s symptoms. Weekly blood work is not required, and adverse effects are not necessarily self-limiting. Doses are taken as scheduled, not adjusted on the short-term basis of symptoms.

Format: Multiple Choice Chapter: 24 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 421, Box 24.1 Focus on Drug Therapy across the Lifespan 5. A client diagnosed with parkinsonism has been told that the levodopa prescribed is no longer controlling the disease. What drug should the nurse question if ordered as adjunctive therapy? A) diphenhydramine B) pramipexole C) trihexyphenidyl D) vitamin B6

Ans: D

Feedback: Vitamin B6 would further decrease the therapeutic effects of levodopa and is contraindicated with levodopa, so the nurse would question this order. Pramipexole, diphenhydramine, and trihexyphenidyl are all useful adjunctive drugs when Parkinson’s disease is no longer controlled with levodopa therapy alone.

Format: Multiple Choice Chapter: 24 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand

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Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 425, Nursing Considerations for Patients Receiving Dopaminergic Agents 6. The nurse provides client teaching about use of levodopa for treatment of Parkinson’s disease. What statement by the client would indicate a good understanding of levodopa? A) “I’ll know within about a year whether this drug has cured my Parkinson’s disease.” B) “I should avoid exercising while taking this drug so that I don’t get injured.” C) “I should take this drug with food to avoid an upset stomach.” D) “I will take multivitamins to ensure that I have good nutrition.”

Ans: C

Feedback: The client should be instructed to take levodopa with meals if GI upset occurs. Clients being treated for Parkinson’s disease should be taught that drug treatment will be needed for life and cannot be stopped in a year. As well, the drug does not cure Parkinson’s disease. The client should continue to be as active as possible. Multivitamins will contain vitamin B6, which should be avoided when taking levodopa.

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B) entacapone C) diphenhydramine D) ropinirole

Ans: A

Feedback: Amantadine is an antiviral drug that increases the release of dopamine and is effective in drug-induced Parkinson’s disease so long as there is a possibility of more dopamine release. Ropinirole is a dopaminergic antiparkinsonism drugs. Entacapone is used as adjunctive treatment of idiopathic Parkinson’s disease with levodopa–carbidopa for clients who are experiencing “wearing off” of drug effects. Diphenhydramine is used, particularly in children, to treat parkinsonism and is also classified as an antihistamine.

Format: Multiple Choice Chapter: 24 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 421, Dopaminergic Agents 8. A client diagnosed with Parkinson’s disease has been prescribed apomorphine to treat the client’s episodes of hypomobility. What should the nurse teach the client regarding administration of the drug? A) “Trimethobenzamide should not be given with apomorphine.” B) “The drug will probably be prescribed intravenously, 50 mg every 3rd day.” C) “The drug will be administered for no more than 2 months.” D) “The drug is usually taken orally, 20 mg three times a day.”

Ans: C

Feedback: It is recommended that trimethobenzamide be started 3 days prior to the

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first dose of apomorphine and should only be continued as needed to control nausea and vomiting, generally no longer than 2 months. Dosage is 2–6 mg subcutaneous PRN doses separated by at least 2 hours.

Format: Multiple Choice Chapter: 24 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 429, Adjunctive Agents 9. An order is written for a drug that is an adjunctive therapy for Parkinson’s disease. The nurse reviews the order before administering the drug. What prescription should the nurse question? A) levodopa 0.5 to 1 g/d orally in two divided doses B) amantadine 200 mg orally b.i.d. C) tolcapone 400 mg orally t.i.d. D) selegiline 10 mg/d orally

Ans: C

Feedback: The order for tolcapone should be questioned. The maximum dose is 600 mg daily. The order is a total of 1,200 mg a day (400 times 3 equals 1,200 mg). The other options are correct dosages.

Format: Multiple Choice Chapter: 24 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 5 Page and Header: 426, Anticholinergic Agents 10. A client has been prescribed benztropine as drug therapy for Parkinson’s disease. What assessment finding would suggest a therapeutic effect to the nurse? A) decreased rigidity and tremors B) increased level of consciousness (LOC) C) increased motivation and muscle strength D) absence of seizure activity

Ans: A

Feedback: Benztropine should cause a decrease in rigidity and tremors. It does not affect LOC, motivation, strength, or seizure risk.

Format: Multiple Choice Chapter: 24 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 421, Dopaminergic Agents 11. A client is newly diagnosed with parkinsonism and has been prescribed levodopa. After several weeks, no appreciable reduction in symptoms has been noted. The nurse should anticipate what change in the client’s medication regimen? A) adding carbidopa to the client’s medication regimen B) addition of vitamin B6 to the client’s medication regimen C) substitution of diphenhydramine for levodopa D) temporary change in levodopa route from oral to intravenous

Ans: A

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Feedback: When levodopa is used with carbidopa, the enzyme dopa decarboxylase is inhibited in the periphery, diminishing the metabolism of levodopa in the gastrointestinal (GI) tract and in peripheral tissues, thereby leading to higher levels crossing the blood– brain barrier. This can enhance the therapeutic effect. Sinemet is only available orally, and vitamin B6 would exacerbate, not reduce, the client’s symptoms. Substituting diphenhydramine would not be effective since it is an adjunct, not a mainstay of treatment.

Format: Multiple Choice Chapter: 24 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 419, Pathophysiology 12. A client diagnosed with advanced Parkinson’s disease has undergone diagnostic testing and diagnostic imaging. What are the results most likely to reveal? A) decreased enzyme dopa decarboxylase levels B) increased gamma-aminobutyric acid (GABA) C) brain infarcts D) degeneration of dopamine-producing nerve cells

Ans: D

Feedback: Classic Parkinson’s disease results from destruction or degenerative changes in dopamine-producing nerve cells in an area of the brain that controls movement. GABA levels are not normally elevated, and the disease does not result from brain infarcts. Dopa decarboxylase levels are affected by the administration of carbidopa.

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Format: Multiple Selection Chapter: 24 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 430, Nursing Considerations for Patients Receiving Adjunctive Agents; 421, Dopaminergic Agents 13. The nurse is caring for a client who has been diagnosed with Parkinson’s disease and whose symptoms are worsening. The health care provider has added a dopaminergic agent to the client’s drug regimen. What is the nurse’s priority assessment after this drug is administered? Select all that apply. A) visual problems B) blood pressure C) urine output D) monitoring for hemorrhage E) skin rashes

Ans: A, B, C

Feedback: GI depression or obstruction, urinary hesitancy or obstruction, benign prostatic hypertrophy, or glaucoma, which may be exacerbated by these drugs, and cardiac arrhythmias, hypertension, or respiratory disease, which may be exacerbated by dopamine receptor stimulation, require the nurse to monitor blood pressure, vision, and urine output carefully. There is no known associated risk for hemorrhage or rashes.

Format: Multiple Choice Chapter: 24 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Teaching/Learning Objective: 5 Page and Header: 426, Anticholinergic Agents 14. The nurse is speaking to a group at the senior citizen’s center about Parkinson’s disease. What should the nurse explain is importance to avoiding when taking an anticholinergic medication? A) strenuous exercise in high environmental temperatures B) salt substitutes and foods high in potassium C) foods high in vitamin K such as dark green, leafy vegetables D) over-the-counter medications containing acetaminophen

Ans: A

Feedback: Anticholinergic drugs decrease sweating. As a result, the body is not as effective at reducing internal temperature which can result in fever and heatstroke. It is important to avoid situations where the client is likely to sweat. Older adults taking anticholinergic drugs do not need to avoid potassium, foods high in vitamin K, or acetaminophen.

Format: Multiple Choice Chapter: 24 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 421, Box 24.1 Focus on Drug Therapy across the Lifespan 15. The nurse is caring for an older adult client who has been diagnosed with Parkinson’s disease and who will soon begin drug therapy. What nursing action will best promote safe and effective drug therapy? A) teaching the family to best match medication doses to the daily severity of the client’s symptoms

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B) detailed education about the need for outpatient blood pressure monitoring C) thorough client and family teaching, supplemented with written materials D) reassurance that many of the client’s symptoms may be normal age-related changes rather than pathologic changes

Ans: C

Feedback: Thorough and individualized client education is necessary to ensure safe and effective treatment. There is not normally a need for frequent blood pressure monitoring for most clients, and drug doses are not changed to address short-term symptoms. The symptoms of Parkinson’s disease are not attributable to normal age-related physiologic changes. Format: Multiple Choice Chapter: 24 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 426, Anticholinergic Agents 16. A client newly diagnosed with Parkinson’s disease has been prescribed an anticholinergic drug. What assessment should the nurse perform when monitoring for adverse effects of anticholinergic agents used for the treatment of Parkinson’s disease? A) monitoring of laboratory results for blood dyscrasias B) focusing on respiratory assessment C) assessing the client’s bowel pattern D) monitoring of prothrombin time and international normalized ratio (INR)

Ans: C

Feedback: Anticholinergics often cause decreased bowel motility, resulting in constipation. This is especially true in older adults. Anticholinergics are not associated with coagulation disorders, blood dyscrasias, or respiratory problems.

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Format: Multiple Choice Chapter: 24 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 4 Page and Header: 421, Dopaminergic Agents 17. A client has been taking levodopa (L-dopa) for the treatment of Parkinson’s disease. What additional medication may decrease the amount of levodopa needed to reach a therapeutic level in the brain, thereby reducing adverse effects of levodopa? A) bromocriptine B) carbidopa C) amantadine D) trihexyphenidyl

Ans: B

Feedback: Carbidopa is frequently given with levodopa in a fixed-dose combination product called Sinemet or Sinemet CR. When used with carbidopa, the enzyme dopa decarboxylase is inhibited in the periphery, diminishing the metabolism of levodopa in the gastrointestinal (GI) tract and in peripheral tissues, thereby leading to higher levels crossing the blood–brain barrier. Because carbidopa decreases the amount of levodopa needed to reach a therapeutic level in the brain, the dosage of levodopa can be decreased, which reduces the incidence of adverse effects. Bromocriptine, amantadine, and trihexyphenidyl may be effective longer than levodopa but are not usually prescribed together.

Format: Multiple Choice Chapter: 24

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Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 420, Treatment 18. The nurse has developed a plan of care for an older adult client who has been newly diagnosed with Parkinson’s disease. What outcome is most likely to be appropriate for this client? A) The client will demonstrate a full return to independent activities of daily living with 2 weeks of starting treatment. B) The client will return to prediagnosis levels of fine motor skill within 48 hours of beginning treatment. C) The client will be oriented to person, place, and time within 48 hours of beginning treatment. D) The client will demonstrate the ability to ambulate the length of the hall within 1 week of starting medication.

Ans: D

Feedback: One goal of drug therapy is to reduce symptoms to allow for more normal movement involving muscles. Goals should be specific and measurable, so the ability to ambulate the length of the hall is a valid assessment. A full return to independence in ADLs may be unrealistic, as is a return to prediagnosis levels of fine motor skills. Cognition is not normally affected during early Parkinson’s disease.

Format: Multiple Choice Chapter: 24 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning

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Objective: 5 Page and Header: 421, Dopaminergic Agents 19. The nurse is teaching a new client who has been diagnosed with Parkinson’s disease about levodopa (L-dopa). What should the nurse instruct the client to avoid using concurrently with L-dopa? A) over-the-counter calcium carbonate tablets B) multivitamin–mineral preparations C) foods that are high in tyramines D) topical corticosteroid ointments

Ans: B

Feedback: Multivitamin preparations should not be given with L-dopa. Corticosteroid ointments, calcium carbonate, and high-tyramine foods are not contraindicated concurrently with L-dopa.

Format: Multiple Choice Chapter: 24 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 421, Dopaminergic Agents 20. When carbidopa is given with levodopa (L-dopa), the dosage of L-dopa may be reduced. What does the reduction in the dosage of L-dopa cause? A) heightened levels of sedation B) prolonged effect of medications C) decreased adverse effects D) decreased effectiveness of symptom control

Ans: C

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Feedback: Because carbidopa decreases the amount of L-dopa needed to reach a therapeutic level in the brain, the dosage of L-dopa can be decreased, which reduces the incidence of adverse effects. This does not reduce effectiveness, prolong the effect, or increase sedation.

Format: Multiple Choice Chapter: 24 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 421, Dopaminergic Agents 21. The nurse is planning the care of a client who has been diagnosed with Parkinson’s disease. What is the main purpose of this client’s medication therapy? A) Adjust the balance of neurotransmitters in the client’s CNS. B) Make the catechol-O-methyltransferase (COMT) inhibitors work better. C) Substitute monoamine oxidase inhibitors (MAOIs) for dopamine agonists. D) Increase the actions of acetylcholine in the brain.

Ans: A

Feedback: Drugs used in Parkinson’s disease increase levels of dopamine (levodopa, dopamine agonists, monoamine oxidase [MAO] inhibitors, COMT inhibitors) or inhibit the actions of acetylcholine (i.e., anticholinergic agents) in the brain. Thus, the drugs help adjust the balance of neurotransmitters. The focus is not primarily on acetylcholine, though this neurotransmitter is involved. MAOIs and COMT are not the purposes of treatment.

Format: Multiple Choice

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Chapter: 24 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 421, Dopaminergic Agents 22. The nurse is teaching a client who has been newly diagnosed with Parkinson’s disease about the appropriate use of levodopa–carbidopa. What should the nurse teach the client? A) Take the daily dose at bedtime to minimize sedative effects. B) Remain seated upright for 30 minutes after taking the medication, if possible. C) Use a moisturizing cream if a rash develops after beginning the medication. D) Take the drug three times each day, at the times that are specified.

Ans: D

Feedback: Consistent scheduling is important to achieving a therapeutic effect of levodopa–carbidopa. It is usually given t.i.d., and there is no need to stay upright after taking it. A rash should be promptly reported.

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A) The client has exhibited adverse effects of medications. B) The client has developed psychological dependence on dopaminergics. C) Levodopa has not caused a sufficient therapeutic response. D) The client’s disease has been deemed incurable.

Ans: C

Feedback: Although anticholinergics are not as effective as levodopa in the treatment of advancing cases of the disease, they may be useful as adjunctive therapies and for clients who no longer respond to levodopa. They are not given in response to adverse effects. Parkinson’s disease is never considered curable. Dopaminergics are not associated with psychological dependence.

Format: Multiple Choice Chapter: 24 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 428, Nursing Considerations for Patients Receiving Anticholinergic Agents 24. A home health nurse is visiting an older adult client who has been diagnosed with Parkinson’s disease. The nurse should assess this client for which signs or symptoms related to common adverse effects? A) skin lesions B) increased dopamine activity C) jaundice D) urinary retention

Ans: D

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Feedback: The nurse would assess the client for urinary retention because this reaction is caused by loss of muscle tone in the bladder and is most likely to occur in older adult men who have enlarged prostate glands. Parkinson’s disease does not generally cause skin lesions. The nurse cannot assess for increased dopamine activity except to assess for reduced symptoms caused by medication therapy. Jaundice is not caused by Parkinson’s disease and is not a common adverse effect of treatment.

Format: Multiple Selection Chapter: 24 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 425, Nursing Considerations for Patients Receiving Dopaminergic Agents 25. An older adult client was diagnosed with Parkinson’s disease 2 years ago, and the client’s symptoms have gradually worsened. What nursing diagnoses are likely to apply to this client? Select all that apply. A) impaired physical mobility related to extrapyramidal symptoms B) risk for autonomic dysreflexia related to CNS disruptions C) disturbed thought processes related to low dopamine levels D) self-care deficit: dressing/grooming related to ataxia E) acute pain related to nociceptor stimulation

Ans: A, D Feedback: Parkinson’s disease causes ataxia, which can impair physical mobility and create a self-care deficit. Thought processes are not normally affected, and the disease does not cause acute pain. Autonomic dysreflexia is related to spinal cord injury, not Parkinson’s disease.

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Format: Multiple Choice Chapter: 24 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 429, Adjunctive Agents 26. A client has a long-standing diagnosis of Parkinson’s disease and has been taking carbidopa–levodopa for 2 years. The nurse has observed that the client is experiencing less and less benefit from the carbidopa–levodopa in recent months. What drug may reverse this trend? A) pramipexole B) safinamide C) ropinirole D) amantadine

Ans: B

Feedback: Safinamide is an adjunctive drug that is prescribed when a client with Parkinson’s disease has a “wearing off” effect of their other Parkinson’s medications, meaning the drugs previously prescribed are having less of an effect. The other listed drugs are not used for this purpose.

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27. The nurse is reviewing the medication administration record (MAR) of a client who has been diagnosed with Parkinson’s disease. The nurse reads that the client is prescribed Stalevo t.i.d. Stalevo is a combination of what drug(s)? Select all that apply. A) entacapone B) selegiline C) carbidopa D) levodopa E) benztropine

Ans: A, C, D

Feedback: Stalevo is combination of entacapone, levodopa, and carbidopa. It does not contain benztropine or selegiline.

Format: Multiple Choice Chapter: 24 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 424, Nursing Care Guide for S.S.: Levodopa 28. The nurse is assessing a client who was prescribed levodopa 1 week earlier. What change in the client’s status would suggest the effectiveness of drug therapy? A) stability of mood B) slower chewing of food C) improved attention span D) improvement in handwriting

Ans: D

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Feedback: The nurse would evaluate the client for improvement in function and reduction in symptoms. With preparations containing levodopa and with dopaminergic agents, assess for improvement in mobility, balance, posture, gait, speech, handwriting, and ability to provide self-care. An improvement in mood may suggest successful treatment. Slower chewing would suggest worsening motor deficits. Attention span is unlikely to be affected.

Format: Multiple Choice Chapter: 24 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 419, Parkinson’s Disease and Parkinsonism 29. When describing Parkinson’s disease to a client with a new diagnosis, what statement made by the nurse would be accurate? A) “Parkinson’s disease can be cured if medication is taken regularly as prescribed.” B) “Degeneration of the neurons can be halted if medications are begun as early as possible.” C) “Symptom management through drug therapy is the current mainstay of treatment.” D) “Surgery has become the most effective intervention for Parkinson’s disease over the past decade.”

Ans: C

Feedback: Surgical procedures involving the basal ganglia have been tried with varying success at prolonging the physical degeneration caused by this disease, but drug therapy remains the primary treatment. At this time, no available treatment arrests the neuron degeneration of Parkinson’s disease and the eventual decline in client function.

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Format: Multiple Choice Chapter: 24 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 421, Box 24.1 Focus on Drug Therapy across the Lifespan 30. The pediatric nurse is preparing to administer an antiparkinsonism drug to a 14year-old client. What is the most likely indication for this use of antiparkinsonian drugs? A) early onset of Parkinson’s disease B) development of parkinsonian effects from recreational drug use C) parkinsonian affects secondary to a connective tissue disorder D) parkinsonian symptoms arising from adverse medication effects

Ans: D

Feedback: The incidence of Parkinson’s disease in children is very low. Children do, however, experience parkinsonian symptoms as a result of drug adverse effects, not of drug abuse. Connective tissue disorders do not normally cause parkinsonian symptoms.

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B) bromocriptine C) levodopa D) ropinirole

Ans: A

Feedback: Only apomorphine can be given parenterally, so this would be an appropriate drug to give to a client with difficulty swallowing. Bromocriptine, levodopa, and ropinirole are only given in oral formulations.

Format: Multiple Selection Chapter: 24 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 421, Dopaminergic Agents 32. The nurse is explaining the therapeutic effects of levodopa to a client diagnosed with Parkinson’s disease. What characteristics of levodopa and dopamine should the nurse describe? Select all that apply. A) Levodopa is a precursor of dopamine. B) Levodopa crosses the blood–brain barrier. C) Levodopa is converted to dopamine. D) Levodopa stimulates the brain to synthesize dopamine. E) Dopamine reverts levodopa for metabolism.

Ans: A, B, C

Feedback: Levodopa is a precursor of dopamine, which is deficient in parkinsonism; it crosses the blood–brain barrier, where it is converted to dopamine and acts as a

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replacement neurotransmitter. Dopamine does not revert to the form of levodopa. Levodopa is not a stimulant for the synthesis of dopamine.

Format: Multiple Choice Chapter: 24 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 426, Anticholinergic Agents 33. The nurse is preparing to administer the client’s first dosage of trihexyphenidyl. What should the nurse tell the client about the dosage? A) “The initial dose is usually 1 to 2 mg and then dosage is gradually increased.” B) “The initial dose is usually 6 mg to establish serum levels and then 1 mg is taken daily.” C) “Generally, a 5-mg dose is taken orally twice a day starting with first dose.” D) “You’ll probably need to take 1 to 2 mg orally every day starting with first dosage.

Ans: A

Feedback: Trihexyphenidyl is given 1 to 2 mg orally daily initially and then titrated up to 6 to 10 mg/d with a maximum of up to 15 mg/d to control symptoms. Trihexyphenidyl is an adjunctive therapy to levodopa in treatment of parkinsonism, but it can be used alone for the control of drug-induced extrapyramidal disorders.

Format: Multiple Choice Chapter: 24 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 5 Page and Header: 419, Parkinson’s Disease and Parkinsonism 34. An older adult client began treatment for Parkinson’s disease several months ago, and the nurse is assessing the client. What assessment finding should suggest that the client’s medications are becoming less effective? A) The client has begun drooling while they eat. B) The client is increasingly impatient with their spouse and children. C) The client has lost interest in their favorite foods. D) The client’s neutrophil count is gradually declining.

Ans: A Feedback: Drooling is a characteristic sign of Parkinson’s disease, and a new onset of this would suggest the progression of the disease. Impatience and loss of interest would suggest a worsening mood and affect, which may or may not be related to the client’s Parkinson’s disease. Neutropenia would likely be unrelated to the disease or its treatment.

Format: Multiple Choice Chapter: 24 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 421, Box 24.1 Focus on Drug Therapy across the Lifespan: Antiparkinsonism Agents 35. Which factor has the greatest influence on the development of Parkinson’s disease? A) ethnicity B) gender C) age D) chronic illness

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Ans: C

Feedback: Although Parkinson’s disease may affect individuals of any age, gender, or race or ethnicity, the frequency of the disease increases with age. Chronic illness is not believed to increase the risk for the development of this disease.

Test Generator Questions, Chapter 25, Muscle Relaxants Format: Multiple Choice Chapter: 25 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 433, Nerves and Movement 1. The nurse is caring for a client who has a disorder of muscle contraction and relaxation. The nurse should prioritize the assessment of what laboratory value? A) calcium B) chloride C) magnesium D) potassium

Ans: A

Feedback: Calcium is released from the sarcoplasmic reticulum, which leads to the binding of calcium with troponin–tropomyosin. This leads to contraction of the muscle fiber. The calcium pump then moves calcium back into the sarcoplasmic reticulum, which leads to relaxation of muscle fiber. Chloride, magnesium, and potassium are not involved in this process.

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Format: Multiple Choice Chapter: 25 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 435, Neuromuscular Abnormalities 2. A client has been diagnosed with cerebral palsy accompanied by muscle spasticity. The nurse should identify what causative factor of this client’s symptoms? A) irreversible injury to muscle tissue B) imbalances between neurotransmitter levels and the levels of enzymes that modulate their reuptake C) inherited defects of the peripheral nervous system D) nerve damage within the central nervous system

Ans: D

Feedback: Muscle spasticity is the result of damage to neurons within the central nervous system (CNS) rather than injury to peripheral structures such as the musculoskeletal system. Serotonin is not involved in the process of muscle contraction and relaxation. The etiology of spasticity is not rooted in neurotransmitter disruptions, even though these may subsequently be affected.

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Page and Header: 436, Centrally Acting Skeletal Muscle Relaxants 3. A nurse is providing discharge teaching for a client who will be going home on cyclobenzaprine prescribed for acute musculoskeletal pain. What health education should the nurse provide? A) Avoid drinking any alcohol until the completion of treatment. B) Take the medication in the morning to avoid nighttime awakenings because of diuresis. C) Avoid taking acetaminophen concurrently with cyclobenzaprine. D) Avoid any supplements that contain vitamin B6.

Ans: A

Feedback: Taking cyclobenzaprine with alcohol can cause an increase in central nervous system depression. Vitamin B6 and acetaminophen are not contraindicated, though this should be discussed with the provider. The effects of CNS depression can be minimized by taking the medication in the evening or at bedtime, if prescribed.

Format: Multiple Choice Chapter: 25 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 436, Centrally Acting Skeletal Muscle Relaxants 4. The nurse provides client teaching about chlorzoxazone in preparation for the client’s discharge to home. The nurse determines that the client understands potential adverse effects when the client makes what statement? A) “This drug can cause diarrhea, so I’ll adjust my diet accordingly.” B) “My urine might change color when I take this drug.” C) “My skin may turn yellow but that will go away once my body adjusts to the drug.” D) “After I take a pill, it might take 2 to 3 hours before I feel the effects.”

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Ans: B Feedback: The client indicates an understanding of adverse effects of this drug by stating that their urine may be discolored while using the drug. Chlorzoxazone may discolor the urine, which will turn orange to purple-red when metabolized and excreted. Clients should be warned about this effect to prevent any fears of blood in the urine. Chlorzoxazone usually causes constipation, not diarrhea. The onset of action is usually within an hour after the drug has been taken. Yellow discoloration of the skin would indicate liver damage or dysfunction, which should be reported immediately.

Format: Multiple Choice Chapter: 25 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 4 Page and Header: 436, Centrally Acting Skeletal Muscle Relaxants 5. The nurse admits a child who has been diagnosed with tetanus after stepping on some old barbed wire fencing. What medication should the nurse expect to administer? A) methocarbamol B) baclofen C) dantrolene D) cyclobenzaprine

Ans: A

Feedback: Methocarbamol is the drug of choice if a child needs to be treated for tetanus. Baclofen and dantrolene are not recommended for use with children. Cyclobenzaprine is not used for the treatment of tetanus.

Format: Multiple Choice

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Chapter: 25 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 436, Centrally Acting Skeletal Muscle Relaxants 6. A client has been experiencing increased muscle spasticity since being diagnosed with multiple sclerosis. What drug is most likely to meet this client’s needs? A) baclofen B) cyclobenzaprine C) metaxalone D) orphenadrine

Ans: A

Feedback: Baclofen is used for treatment of muscle spasticity associated with neuromuscular diseases such as multiple sclerosis. Cyclobenzaprine, metaxalone, and orphenadrine are used for relief of discomfort associated with painful, acute musculoskeletal conditions.

Format: Multiple Choice Chapter: 25 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 441, Patient Teaching for M.D. 7. The nurse is caring for four clients. Which client would have the highest risk for hepatotoxicity from dantrolene? A) a man who is taking a cardiac glycoside

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B) a man who is taking an antipsychotic drug C) a woman who is on hormone replacement therapy D) a woman who is taking a loop diuretic

Ans: C

Feedback: If dantrolene is combined with estrogen, the incidence of hepatocellular toxicity is increased. This combination should be avoided. Nothing indicates that clients taking a cardiac glycoside, an antipsychotic drug, and an antihypertensive would have serious adverse effects when combined with dantrolene therapy.

Format: Multiple Choice Chapter: 25 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 436, Centrally Acting Skeletal Muscle Relaxants 8. The nurse is working with a client who has been prescribed tizanidine for the treatment of muscle spasticity. When monitoring the client’s risk for injury, what assessment should the nurse prioritize? A) assessment of bowel sounds and pattern of bowel movements B) assessment for headaches following peak blood levels C) assessment of the client’s creatinine clearance rate D) assessment of the client’s blood pressure following administration

Ans: D Feedback: Tizanidine has been associated with hypotension, which could be a safety risk especially if the client is also taking an antihypertensive drug. Constipation and headaches are common adverse effects that do not pose as direct a safety risk. Creatinine levels are not normally affected, and these do not pose a safety risk.

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Format: Multiple Choice Chapter: 25 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 439, Direct-Acting Skeletal Muscle Relaxants 9. A client attends a “Botox Party” and is injected with botulinum toxin type A to decrease frown lines between their eyebrows. Later that evening, the client is admitted to the emergency department and is distraught because they cannot move their eyebrows. What does the nurse explain the toxin causes? A) “The toxin causes muscle death, which smooths wrinkles in the area.” B) “The toxin causes muscle paralysis, preventing movement and relieving wrinkles.” C) “The drug is a toxin to nerves in the area.” D) “The drug is a permanent muscle relaxant, and the muscles will never move again.”

Ans: B

Feedback: Botulinum toxin types A and B bind directly to the receptor sites of motor nerve terminals and inhibit the release of acetylcholine, leading to local muscle paralysis. These two drugs are injected locally and used to paralyze or prevent the contractions of specific muscle groups. The action smooths wrinkles in the area but does not cause muscle death. The effect is temporary and does not cause nerve death. The other options are false statements.

Format: Multiple Choice Chapter: 25 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 436, Centrally Acting Skeletal Muscle Relaxants 10. A client presents to the emergency department and states stepping on a rusty nail 2 days ago. Upon assessment, the client exhibits signs of muscle rigidity and contractions. The nurse should expect to administer which medication? A) carisoprodol B) cyclobenzaprine C) metaxalone D) methocarbamol

Ans: D

Feedback: The client is exhibiting signs of tetanus, and methocarbamol is indicated for treatment. Carisoprodol, cyclobenzaprine, and metaxalone are not used to treat tetanus.

Format: Multiple Choice Chapter: 25 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Difficulty: Easy Integrated Process: Communication and Documentation Objective: 1 Page and Header: 435, Neuromuscular Abnormalities 11. The nurse assesses a newly admitted client and finds the muscle tone in their left leg has sustained muscle contraction and that the client is unable to relax the muscle even when prompted. What is the nurse’s most appropriate action? A) Administer phenytoin as prescribed. B) Administer diphenhydramine as prescribed. C) Document the fact that the client has atonic muscles. D) Document the presence of muscle spasticity.

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Ans: D

Feedback: Muscle spasticity is defined as a sustained muscle contraction. Soft and flabby muscle tone is defined as atonic. Phenytoin and diphenhydramine are not used to treat muscle spasticity.

Format: Multiple Choice Chapter: 25 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 440, Nursing Care Guide for M.D.: IncobotulinumtoxinA 12. A client presents to the clinic to receive a Botox injection in their forehead. The client has adult acne across their forehead. What is the nurse’s priority action? A) Hold the injection and consult the health care provider. B) Cleanse the area well with an antibacterial soap. C) Apply a topical antibiotic after administering the Botox. D) Provide client information about post-Botox injection care. Ans: A

Feedback: Botulinum toxins should not be injected into any area with an active infection because of the risk of exacerbation of the infection. As a result, the nurse would hold the injection and consult with the health care provider, with the expectation the medication would be held until the acne resolved. Cleansing the area well, applying a topical antibiotic, and providing information about postinjection care would not resolve the problem and are not indicated.

Format: Multiple Selection

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Chapter: 25 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 435, Neuromuscular Abnormalities 13. What client(s) should the nurse recognize as having a health problem that could result in muscle spasm? Select all that apply. A) a client who overstretched a muscle during a vigorous workout B) a client who sustained an accidental gunshot injury to their leg C) a client who tore a leg tendon in a soccer game D) a school-aged client who fractured their radius on the playground E) an older adult client with Parkinson’s disease

Ans: A, C

Feedback: Muscle spasms often result from injury to the musculoskeletal system (e.g., overstretching a muscle, wrenching a joint, tearing a tendon or ligament). These injuries can cause violent and painful involuntary muscle contractions. A bone fracture or gunshot injury would be less likely to cause muscle spasms. Parkinson’s disease affects the neurologic system and causes ataxia, but less often causes muscle spasms.

Format: Multiple Selection Chapter: 25 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 5 Page and Header: 441, Patient Teaching for M.D.

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14. The nurse is giving discharge instructions to a client who just had Botox A injections around their eyes. The nurse should caution the client about what potential adverse effect(s)? Select all that apply. A) development of respiratory infections B) flulike symptoms C) droopy eyelids D) blurred vision or diplopia E) muscle spasms

Ans: A, B, C

Feedback: Adverse effects associated with use of botulinum toxin type A for cosmetic purposes include headache, respiratory infections, flulike syndrome, and droopy eyelids in severe cases. Adverse effects do not typically include vision changes or muscle spasms.

Format: Multiple Choice Chapter: 25 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 439, Direct-Acting Skeletal Muscle Relaxants 15. A client with a complex health history has developed severe spasticity. What aspect of the client’s status would contraindicate the safe and effective use of dantrolene? A) The client has a history of fatty liver disease. B) The client has type 2 diabetes and takes oral antihyperglycemics. C) The client has asthma and occasionally uses an inhaled corticosteroid. D) The client requires partial assistance with activities of daily living.

Ans: A

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Feedback: Dantrolene is contraindicated in the presence of any known allergy to the drug. It is also contraindicated in the following conditions: spasticity that contributes to locomotion, upright position, or increased function, which would be lost if that spasticity was blocked; active hepatic disease (such as fatty liver disease), which might interfere with metabolism of the drug and because of known liver toxicity; and lactation because the drug may cross into breast milk and cause adverse effects in the infant. Diabetes, asthma, and lack of independence do not contraindicate the use of dantrolene.

Format: Multiple Choice Chapter: 25 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 439, Direct-Acting Skeletal Muscle Relaxants 16. A 31-year-old female client has been taking dantrolene for several years with good effect. The client has presented to the clinic because they just had a positive home pregnancy test. In addition to referring the client to their primary care provider, the nurse should provide what teaching? A) “Your provider will likely want to discontinue the drug for the rest of your first trimester, since that when organs are forming.” B) “Dantrolene is in pregnancy category A, which means it’s been shown safe to use in pregnancy.” C) “Your provider will likely choose an alternative muscle relaxant since dantrolene has been linked to spontaneous abortion.” D) “You and your care provider will have to carefully consider whether it will be safe for you to continue taking dantrolene.”

Ans: D

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Feedback: Dantrolene is not absolutely contraindicated during pregnancy, but the risks versus benefits must be carefully weighed. It would not be withheld for only part of the pregnancy, and it is not a category A medication.

Format: Multiple Choice Chapter: 25 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 433, Nerves and Movement 17. What are the simplest nerve pathways in the body? A) arc reflexes B) spinal reflexes C) afferent nerve reflexes D) spindle gamma loop

Ans: B

Feedback: The spinal reflexes are the simplest nerve pathways that monitor movement and posture. Arc reflexes and afferent nerve reflexes are distracters for this question. Spindle gamma loops respond to stretch receptors.

Format: Multiple Choice Chapter: 25 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2

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Page and Header: 436, Centrally Acting Skeletal Muscle Relaxants 18. An older adult with lumbar pain has been prescribed cyclobenzaprine. What nursing diagnosis should the nurse prioritize? A) chronic confusion related to CNS depression B) diarrhea related to GI stimulation C) risk for falls related to CNS depression D) risk for deficient fluid volume related to vomiting and diaphoresis

Ans: C

Feedback: The CNS depression that results from muscle relaxants creates a significant risk for falls, especially in older adults. Constipation is more likely than diarrhea, and fluid imbalances are not anticipated. Cognition changes may occur, but these would be short-term during drug therapy, not chronic.

Ans: A

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Feedback: Baclofen is available in oral and intrathecal forms and can be administered via a delivery pump for the treatment of central spasticity. Soma cannot be delivered in this manner, and there is no obvious reason to question such an order. The client likely needs venous access for other fluids and medications, but it is not necessary for intrathecal administration.

Format: Multiple Selection Chapter: 25 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 436, Centrally Acting Skeletal Muscle Relaxants 20. A client with muscle spasticity has begun taking baclofen. What recent assessment finding(s) should the nurse attribute to possible adverse effects? Select all that apply. A) Heart rate 61 beats/min, regular rhythm. B) Blood pressure 103/59 mm Hg. C) The client reports frequent urges to void. D) The client reports light-headedness transitioning from lying to sitting. E) Most recent laboratory blood results suggest leukopenia.

Ans: B, C, D

Feedback: Adverse effects include transient drowsiness, dizziness, weakness, fatigue, constipation, headache, insomnia, hypotension, nausea, and urinary frequency. Leukopenia and bradycardia are not associated with baclofen.

Format: Multiple Selection Chapter: 25 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 439, Direct-Acting Skeletal Muscle Relaxants 21. When caring for a client taking dantrolene, for what adverse effect(s) should the nurse monitor the client? Select all that apply. A) bradycardia B) jaundice C) urinary retention D) fatigue E) drowsiness Ans: B, D, E

Feedback: Adverse effects of dantrolene include drowsiness, dizziness, weakness, fatigue, diarrhea, hepatitis, myalgia, tachycardia, transient blood pressure changes, rash, and urinary frequency. Hepatitis and other forms of liver damage could be indicated by the development of jaundice. Adverse effects of dantrolene do not include bradycardia or urinary retention.

Format: Multiple Selection Chapter: 25 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 443, Nursing Considerations for Patients Receiving Direct-Acting Skeletal Muscle Relaxants 22. The nurse is caring for a client who is having a pump placed to deliver intrathecal baclofen and another client who will receive dantrolene as a muscle relaxant. What nursing diagnosis would be appropriate for both care plans? Select all that apply.

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A) impaired comfort related to GI and CNS effects of drug B) risk for injury related to central nervous system (CNS) effects C) disturbed body image related to muscle pain D) disturbed thought processes related to CNS effects E) deficient knowledge related to procedure

Ans: A, B, D

Feedback: Acute pain related to GI effects of drug, risk for injury related to CNS effects, and disturbed thought processes related to CNS effects all apply to both clients. Disturbed body image may apply to the client having the pump placed, but this is not related to muscle pain. Only the client having the pump placed would need information related to the procedure.

Format: Multiple Choice Chapter: 25 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 438, Nursing Considerations for Patients Receiving Centrally Acting Skeletal Muscle Relaxants 23. The nurse is caring for a client who is being discharged home from the rehabilitation unit. Baclofen will be discontinued, and the client will begin taking carisoprodol as an outpatient. What is the nurse’s primary consideration when discontinuing the client’s baclofen? A) The client’s dose of baclofen should be gradually withdrawn over 4 to 6 weeks to prevent rebound spasticity. B) “The client will be prescribed alternate doses of baclofen and carisoprodol over 10 days to prevent symptoms of baclofen withdrawal.”

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C) “Baclofen must be tapered down over 1 to 2 weeks to prevent psychoses and hallucinations.” D) “Carisoprodol will be administered while continuing baclofen until the carisoprodol level is established.”

Ans: C

Feedback: If using baclofen, taper drug slowly over 1 to 2 weeks to prevent the development of psychoses and hallucinations. Giving both drugs at once would risk toxicity and serious adverse effects and would never be done. Four to six weeks is unnecessary for the transition.

Format: Multiple Choice Chapter: 25 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 436, Centrally Acting Skeletal Muscle Relaxants 24. The nurse is preparing to administer a hospital client’s scheduled dose of baclofen 20 mg PO. Prior to administering the medication, the nurse has performed an assessment which indicated that the client’s blood pressure is 151/98 mm Hg. What is the nurse’s best action? A) Withhold the scheduled dose of baclofen and document the assessment findings. B) Contact the care provider immediately. C) Withhold the medication and reassess the client in 30 to 60 minutes. D) Administer the medication as prescribed.

Ans: D

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Feedback: This client is hypertensive. However, baclofen carries no risk for exacerbating the client’s high blood pressure but rather it may result in a drop in blood pressure, and there is no obvious rationale for withholding it. The client’s blood pressure should be addressed by the care team, but there is likely no reason to contact the care provider on an emergency basis.

Format: Multiple Choice Chapter: 25 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 439, Direct-Acting Skeletal Muscle Relaxants 25. A client has been diagnosed with multiple sclerosis and experiences spasticity in several muscle groups. What drug would the nurse anticipate will be ordered as the drug of choice to manage spasticity associated with neuromuscular diseases? A) dantrolene B) baclofen C) carisoprodol D) botulinum toxin type B

Ans: A

Feedback: Dantrolene directly affects peripheral muscle contraction and has become important in the management of spasticity associated with neuromuscular diseases. Baclofen, carisoprodol, and botulinum toxin type B are not the drugs of choice for management of spasticity in neuromuscular disease.

Format: Multiple Choice Chapter: 25

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 441, Patient Teaching for M.D. 26. General anesthetic has been administered to a surgical client, and the client has begun to exhibit signs and symptoms of malignant hyperthermia. The operating room nurse should prepare to assist with the administration of what medication? A) orphenadrine B) metaxalone C) chlorzoxazone D) dantrolene

Ans: D

Feedback: Indications for dantrolene include control of clinical spasticity resulting from upper motor neuron disorders; preoperatively to prevent or attenuate the development of malignant hyperthermia in susceptible clients; IV for management of fulminant malignant hyperthermia. The other drugs are not indicated for treatment of malignant hyperthermia.

Format: Multiple Choice Chapter: 25 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 434, Brain Control

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27. The nurse is observing a client who is labeling the numbers on a drawing of a clock during a neurologic assessment. What should the nurse recognize that the client is using when making precise, intentional movements such as handwriting? A) pyramidal tract B) substantia nigra C) Broca’s area D) extrapyramidal tract Ans: A

Feedback: Upper-level controls of muscle activity include the pyramidal tract in the cerebellum, which regulates precise intentional muscle movement, and the extrapyramidal tract in the cerebellum and basal ganglia, which coordinates crude movements often related to unconscious muscle activity. Broca’s area has to do with speech, not movement. The substantia nigra does not control muscle movement.

Format: Multiple Choice Chapter: 25 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 436, Centrally Acting Skeletal Muscle Relaxants 28. The client reports pain caused by muscle spasms in their back. The nurse assesses the client as being very anxious due to intense psychosocial stressors and notes how the anxiety results in tensing of muscles. What medication would be most effective in treating this client? A) baclofen B) botulinum toxin type B C) dantrolene D) diazepam

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Ans: D

Feedback: Adults complaining of muscle spasm pain that may be related to anxiety often respond very effectively to diazepam, which is a muscle relaxant and anxiolytic. Although many drugs, including baclofen, will treat the muscle spasm, diazepam also reduces anxiety. Dantrolene would be better indicated for spasticity than for spasm, and botulinum toxin type B is not prescribed for either anxiety or muscle spasm.

Format: Multiple Choice Chapter: 25 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 436, Centrally Acting Skeletal Muscle Relaxants 29. After administering a centrally acting skeletal muscle relaxant, what other independent nursing measures might the nurse implement to relieve pain and reduce spasm? A) physical therapy for the affected muscle B) application of heat to the affected region C) deep tissue massage D) administration of a nonsteroidal antiinflammatory drug

Ans: B

Feedback: Other measures in addition to drugs should be used to alleviate muscle spasm and pain. The nurse can independently encourage rest of the affected muscle and provide heat applications to increase blood flow to the area to remove the pain-causing chemicals. Deep tissue massage could cause damage and is not an independent nursing action. Similarly, administration of an NSAID requires an order.

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Format: Multiple Choice Chapter: 25 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 436, Centrally Acting Skeletal Muscle Relaxants 30. The nurse is caring for a client with an infusing IV who is allowed nothing by mouth due to a paralytic ileus. What centrally acting medication could the nurse administer to this client? A) chlorzoxazone B) carisoprodol C) cyclobenzaprine D) orphenadrine

Ans: D

Feedback: Only orphenadrine of these options can be given parenterally, either IV or intramuscularly. The other options are available for oral use only.

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A) Confirm the client’s identity and administer the medication as prescribed. B) Contact the prescriber to confirm the route. C) Contact the prescriber to confirm the frequency. D) Contact the prescriber to confirm the dose.

Ans: D

Feedback: The normal daily dosage of cyclobenzaprine is 10 mg taken orally t.i.d., and it can be increased to a maximum of 60 mg/day. As a result, the nurse must clarify this potentially unsafe dose. Confirming the client’s identity, the route, and frequency are important actions but not the priority at this time.

Format: Multiple Choice Chapter: 25 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 433, Box 25.1 Focus on Drug Therapy across the Lifespan: Skeletal Muscle Relaxants 32. A child experiencing muscle spasticity is prescribed onabotulinumtoxinaA. What assessment should the nurse identify as being the priority? A) cardiac B) respiratory C) gastrointestinal D) integumentary

Ans: B

Feedback: IncobotulinumtoxinA and onabotulinumtoxinaA are approved for use in children for treatment of muscle spasticity. The most common side effect in children was

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upper respiratory infection. There is no known relationship between these drugs and any cardiac, gastrointestinal, or integumentary disorders.

Format: Multiple Selection Chapter: 25 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 433, Box 25.1 Focus on Drug Therapy across the Lifespan: Skeletal Muscle Relaxants 33. When providing education to a client recuperating from a muscle injury, what factor regarding muscle recovery should the nurse stress? Select all that apply. A) application of heat B) benefit of massage C) resting the muscle D) benefit of physical therapy E) need for nutritional supplements

Ans: A, B, C, D

Feedback: Rest of the muscle, heat, massage, and physical therapy are key components to recovery from any muscular injury or pain. While good nutrition is a general need, it is not necessarily derived from supplements.

Test Generator Questions, Chapter 26, Opioid Agonists, Opioid Antagonists, and Antimigraine Agents Format: Multiple Choice Chapter: 26

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Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 451, Box 26.1 Focus on Drug Therapy across the Lifespan: Opioids 1. A geriatric client received a narcotic analgesic before leaving the postanesthesia care unit to return to the regular unit. What is the priority nursing intervention for the nurse receiving the client on the regular unit? A) Maintain the head of the client’s bed at ≥45°. B) Encourage fluid intake. C) Create a restful, dark, quiet environment. D) Put side rails up and place bed in low position.

Ans: D

Feedback: Older clients are more susceptible to the central nervous system effects of narcotics; it is important to ensure their safety by using side rails and placing the bed in the low position in case the client tries to get up unaided. Postoperative clients are allowed nothing by mouth until bowel function returns, so an oral medication or encouraging fluids would not be appropriate. This client will require careful observation for respiratory depression, so a dark room would be unsafe. There is no need to keep the head of the client’s bed raised.

Format: Multiple Choice Chapter: 26 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 455, Critical Thinking Scenario: Using Morphine to Relieve Pain

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2. A client has been experiencing severe pain and is being treated with narcotics. What should the nurse include in the plan of care as a desirable and measurable outcome for this client? A) reduced periods of time between requests for medication B) reduced resting heart rate C) maintaining one position for a prolonged period of time D) increased independence with AM care

Ans: D

Feedback: Monitor client’s response to the drug (e.g., relief of pain, sedation). When pain is being adequately managed with opioid therapy, a desirable and measurable outcome would be that the client is able to be more autonomous in providing care in the morning. Shorter periods between requests for medication may suggest that pain is becoming worse, not better. Clients in pain tend not to move for fear of exacerbating the pain, so lack of movement can be an indication the client is in pain. Pain tends to increase an individual’s heart rate, but a reduction is heart rate does not necessarily indicate successful pain management.

Format: Multiple Choice Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 450, Opioids 3. The health care provider (HCP) prescribes codeine 20 mg PO q4h as an adjunctive therapy to an adult client’s NSAID. What is the nurse’s best action? A) Contact the HCP to question the dose. B) Contact the HCP to question the frequency of administration. C) Contact the HCP to question concurrent use of an NSAID and codeine.

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D) Administer the medication as prescribed and monitor the client’s pain.

Ans: D

Feedback: The correct dosage for codeine administered for pain by mouth is 15 to 60 mg q4–6h. Narcotics and NSAIDs can be safely administered at the same time. Consequently, there is no apparent need to question this order.

Format: Multiple Choice Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 5 Page and Header: 462, Antimigraine Agents 4. A client with migraine headaches is changed from an ergot to a prescription for a triptan. The nurse has provided health education related to the new medication. What statement would indicate that the client has a clear understanding of the new medication? A) “I’ll keep a close watch for any changes in the color of my urine.” B) “I can resume my normal driving habits because this medication isn’t sedating.” C) “I shouldn’t experience as many adverse effects from my new medication.” D) “I can take my medication every hour when I have a headache.”

Ans: C

Feedback: Triptans are a new class of selective serotonin receptor blockers that cause vasoconstriction; they are not associated with as many systemic adverse effects as experienced in ergot therapy. Although adverse effects are fewer than those associated with ergot therapy, triptans can still cause dizziness, feelings of strangeness, and vertigo, so the client should not drive while taking the drug. Triptans are often only

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taken once due to prolonged half-lives, but some may be repeated in 2 to 4 hours if the headache does not subside. Urine discoloration is not a noted adverse effect.

Format: Multiple Choice Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Page and Header: 464, Triptans 5. A client experiences short-lived, intense headaches that tend to occur in cycles, often with lengthy periods of remission. What medication is most likely to meet this client’s needs? A) almotriptan B) frovatriptan C) naratriptan D) sumatriptan

Ans: D Feedback: Sumatriptan is approved for the treatment of cluster headaches in adults. No other triptans are approved for treatment of cluster headaches.

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6. The nurse is preparing to administer an ergot drug to a client for the first time. What other medication that the client is taking should cause the nurse to question the order? A) an oral hypoglycemic B) a beta-adrenergic blocker C) an oral contraceptive D) a selective serotonin reuptake inhibitors (SSRIs)

Ans: B

Feedback: The concurrent use of beta-blockers and ergot preparations increases the client’s risk for peripheral ischemia and gangrene. This combination should be avoided. There is no indication for concern with the use of antidiabetic agents, SSRIs, and oral contraceptives with these drugs.

Format: Multiple Selection Chapter: 26 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 448, Pain Impulse Transmission and Perception 7. A client is experiencing pain. What are being stimulated in this client? Select all that apply. A) A-delta fibers B) A-delta sensory nerves C) mu-receptors D) sigma-receptors E) C fibers

Ans: A, E

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Feedback: Two small-diameter sensory nerves, A-delta and C fibers, respond to stimulation by generating nerve impulses that produce pain sensations. Large-diameter sensory nerves (i.e., A fibers) transmit sensations associated with touch and temperature. Mu-receptors are primarily pain-blocking receptors; sigma-receptors cause papillary dilation and may be responsible for the hallucinations, dysphoria, and psychoses that can occur with narcotic use.

Format: Fill-in-the-Blank Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 451, Opioid Agonists 8. A nurse is caring for a 6-year-old client after surgery. The child has an order for meperidine 1.8 mg/kg IM every 3 to 4 hours as needed for pain. The child weighs 30 kg, and the meperidine is available as 50 mg/mL. What is the correct amount of mL that the nurse should administer per dose? Record your answer to the nearest tenth.

Ans: 1.1 mL

Feedback: To calculate the correct amount to be administered, first multiply 1.8 mg × 30 kg (54 mg). Next determine the volume in milliliter that 54 mg is equal to (50 mg: 1 mL as 54 mg: × mL). Solve for × (50× is equal to 54 mg; 54 divided by 50 is equal to 1.08 mL). To one decimal place, 1.08 mL is 1.1 mL.

Format: Multiple Choice Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 462, Antimigraine Agents 9. A client experiencing a migraine took a prescribed dose of eletriptan, and 1-hour later, the headache is still intense. The client’s partner calls the clinic and asks the nurse what they should do. What is an appropriate nursing response? A) “Tell them to lie down in a quiet cool room and just wait it out. It will subside.” B) “They can take another dose of the drug 2 hours after the initial dose if the headache continues.” C) “Give them a dose of an ergot drug if you have it. It will decrease the intensity of the pain.” D) “Ibuprofen may increase the action of the triptan.”

Ans: B Feedback: A client taking eletriptan to relieve a migraine can take another dose in 2 hours if the headache is not relieved. The combination of ergot drugs with triptans is not indicated because of the vasoconstriction caused by both. The client will not get relief by “waiting it out.” Ibuprofen is an antiinflammatory that does not affect the mechanism associated with migraines.

Format: Multiple Choice Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 451, Opioid Agonists 10. The nurse is caring for a client who is receiving morphine via patient-controlled analgesia (PCA). In addition to pain assessment, what assessments should the nurse prioritize?

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A) apical heart rate and temperature B) level of consciousness and respiratory rate C) respiratory rate and fluid balance D) urine output and inspection of the IV site

Ans: B

Feedback: The nurse should assess respiratory rate and level of consciousness because respiratory depression and sedation are adverse effects of opioid analgesics. None of the other assessment parameters is as likely to be volatile as LOC and respiratory rate.

Feedback: 10 mg = 1 mL and a dose of 2.5 mg is ordered. 10 mg/1 mL: 2.5 mg/X. Cross-multiply to yield 2.5 mg = 10X. Divide each side by 10 to learn the nurse should administer 0.25 mL.

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Format: Multiple Choice Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 5 Page and Header: 455, Critical Thinking Scenario: Using Morphine to Relieve Pain 12. A client is in the hospital recovering from surgery. The client’s adult child tells the nurse that they are concerned their parent will overdose on morphine because they keep pressing the button on the patient-controlled anesthesia (PCA) pump. In addition to reassessing the client’s pain, what is the nurse’s best response? A) “I’ll teach you some techniques to take their focus off the pain so they don’t press the button so often.” B) “If they follow the directions given, that will not happen.” C) “I’ll come and teach them again how to use the PCA safely and effectively.” D) “The device has maximum limits programmed, so your parent cannot get more than a specific amount.”

Ans: D

Feedback: A PCA system using morphine provides a baseline, constant infusion of morphine and gives the client control of the system to add bolus doses of morphine if the client believes that pain is not being controlled. The system prevents overdose by locking out extra doses until a specific period of time has elapsed. Offering to teach relaxation techniques to the family member does not address the expressed concern.

Format: Multiple Choice Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand

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Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 450, Opioids 13. A client diagnosed with a viral respiratory infection has an intense headache and cough. What drug will best address both of this client’s symptoms? A) codeine B) hydromorphone C) ibuprofen D) acetaminophen

Ans: A

Feedback: Codeine is a narcotic drug used for its analgesic and antitussive effects. Hydromorphone, ibuprofen, and acetaminophen do not have antitussive effects.

Format: Multiple Selection Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 451, Opioid Agonists; 456, Opioid Agonists–Antagonists 14. The nurse is admitting a client to the postsurgical unit from the postanesthetic care unit. The client is in pain, so the nurse administers 4 mg morphine IV as prescribed. After administering the drug, the PACU nurse calls to say a dose of morphine was given and not documented. What action(s) should the nurse perform? Select all that apply. A) Ensure naloxone is readily available. B) Inform the client’s health care provider. C) Administer buprenorphine as prescribed. D) Document the event.

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E) Monitor the client’s respiratory rate closely. F) Arrange for cardiac monitoring.

Ans: A, B, D, E

Feedback: The nurse should inform the care team and document this event. Close respiratory monitoring would be necessary, but cardiac monitoring would not likely be required. Naloxone is the drug of choice for treatment of opioid overdose and should be readily available. Buprenorphine hydrochloride is a narcotic–agonist–antagonist and would suppress respirations further.

Ans: C

Feedback: Orthostatic hypotension is commonly seen in association with some narcotics. For most clients, changes in blood pressure are most likely than dysrhythmias, ataxia, and changes in vision.

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Format: Multiple Choice Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 451, Opioid Agonists 16. The nurse receives a prescription for morphine sulfate 8 mg IV every hour as needed for pain. For what client should the nurse question this order? A) a 78-year-old client with osteoarthritis B) a 45-year-old client, 1-day postoperative mastectomy C) a 28-year-old client with a fractured tibia D) a 17-year-old client, 1-day postoperative appendectomy

Ans: A

Feedback: Older clients are more likely to experience the adverse effects associated with narcotics, including central nervous system, gastrointestinal, and cardiovascular effects. Furthermore, a strong narcotic analgesic would not be indicated for chronic osteoarthritis pain. For both of these reasons, the nurse would question the large dosage of a narcotic. The other clients could appropriately receive morphine 8 mg unless they were smaller than average adults.

Format: Multiple Choice Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning

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Objective: 4 Page and Header: 451, Opioid Agonists 17. The nurse is preparing to administer morphine IV to a client who has been diagnosed with multiple trauma. Before administering the morphine, what common adverse effect should the nurse inform the client about? A) paresthesia in lower extremities B) occipital headache C) photophobia D) drowsiness

Ans: D

Feedback: Common adverse effects include dizziness, drowsiness, and visual changes. Morphine does not commonly cause paresthesia in the lower extremities, an occipital headache, or photophobia.

Format: Multiple Choice Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 448, Pain 18. The nurse administers hydromorphone IV to the postoperative client as prescribed. What is the best method for the nurse to evaluate the client’s response to the medication? A) Observe the client’s behavior without the client’s awareness, 30 minutes after administration. B) Use a pain assessment tool before and 30 minutes after administration. C) Assess the client’s vital signs before and after drug administration. D) Ask the client if the medication has been effective.

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Ans: B

Feedback: A standard pain assessment tool should be used both pre- and postanalgesia. This type of quantitative data are more accurate than asking the client a yes/no question about the effectiveness of the medication. The nurse should observe the client’s response, but this does not provide the most accurate assessment data. Similarly, vital signs should be monitored, but trends do not necessarily demonstrate effectiveness.

Format: Multiple Choice Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 456, Opioid Agonists–Antagonists 19. A client has been taking morphine PO for several months following a back injury. The care team is working with the client to wean the client off morphine. The client reports that they are getting minimal relief from the pain with the new nonopioid medication they are receiving. What should the nurse suspect is causing this client’s pain? A) Administer a higher dose of morphine, as prescribed. B) Assess the client for further signs of addiction. C) Assess the client for further signs of withdrawal syndrome. D) Monitor the client for hypersensitivity.

Ans: C

Feedback: Caution should be used in cases of physical dependence on a narcotic because a withdrawal syndrome may be precipitated, the narcotic antagonistic properties can block the analgesic effect, and so intensify the pain. It is important to differentiate

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between addiction and dependence because addiction generally does not occur in clients receiving narcotics for medical reasons. There is no indication of a hypersensitivity reaction. Giving a higher dose of the opioid would eliminate the progress made to date on weaning the client from the narcotic, so attempts should be made to avoid this intervention.

Ans: C, D

Feedback: Narcotics that have an established pediatric dose include codeine, fentanyl (but not the transdermal form), meperidine, and morphine. Neither methadone nor hydrocodone is recommended as an analgesic in children.

Format: Multiple Choice Chapter: 26

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 4, 5 Page and Header: 451, Opioid Agonists 21. The nurse administers morphine 15 mg oral solution to a client with cancer pain at 09:30. What time should the nurse reassess the client for peak analgesic effect? A) 09:45 B) 10:00 C) 10:30 D) 11:00

Ans: C

Feedback: With oral administration, peak activity occurs in about 60 minutes. The duration of action is 5 to 7 hours.

Format: Multiple Choice Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 451, Opioid Agonists 22. A hospital client’s pain is rated at 9/10, and the nurse is preparing to administer 4 mg hydromorphone PO as prescribed. What are the appropriate interventions by the nurse prior to administering the medication? A) Ensure that the client is aware of NSAID alternatives to this narcotic. B) Assess the client’s apical heart rate for 1 minute. C) Assess the client’s baseline respiratory rate.

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D) Ensure that there is naloxone available at the bedside.

Ans: C

Feedback: The nurse should check the client’s rate, depth, and rhythm of respirations before each dose. Bradycardia would contraindicate safe use, but this does not necessarily require 1-minute auscultation of a client’s heart rate. Naloxone should be available but does not need to be at the client’s bedside. Teaching about alternatives would depend on the client’s status, the current prescriptions, and the client’s pain level.

Format: Multiple Choice Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 464, Triptans 23. A client with a history of migraines has been prescribed sumatriptan and is experiencing relief. What physiologic response is the client most likely experiencing? A) vasoconstriction of cranial blood vessels B) increased synthesis and release of endorphins C) stimulation of A-delta D) stimulation of C fibers

Ans: A

Feedback: Sumatriptan binds to serotonin receptors to cause vasoconstrictive effects on cranial blood vessels. It does not directly influence endorphin levels. Stimulation of Adelta and C fibers causes increased, not decreased, pain levels.

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Format: Multiple Choice Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 456, Opioid Agonists–Antagonists 24. The nurse is caring for a client who has experienced little pain relief. The care team is considering the use of pentazocine. What aspect of the client’s current status would necessitate cautious use of pentazocine? A) The client has diverticulosis. B) The client had a myocardial infarction 18 months ago. C) The client takes over-the-counter laxatives and stool softeners regularly. D) The client has smoked cigarettes for four decades.

Ans: B

Feedback: Pentazocine must be administered cautiously to clients with known heart disease because the drug may cause cardiac stimulation including arrhythmias, hypertension, and increased myocardial oxygen consumption, which could lead to angina, myocardial infarction, or congestive heart failure. The client’s gastrointestinal function would not require cautious use. Smoking has a negative effect on the client’s cardiac function but does not preclude the use of pentazocine.

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Page and Header: 459, Nursing Considerations for Patients Receiving Opioid Agonists and Opioid Agonists–Antagonists 25. The nurse is caring for a client whose pain is being treated with pentazocine. What would be an appropriate nursing diagnosis for this client’s care plan? A) diarrhea related to adverse gastrointestinal effects B) risk for autonomic dysreflexia related to central nervous system depression C) risk for infection related to immune system depression D) impaired gas exchange related to respiratory depression

Ans: D

Feedback: Nursing diagnoses may include impaired gas exchange related to respiratory depression. The drug is more likely to cause constipation due to slowing of the GI tract instead of diarrhea. The drug has no effect on immune function. Autonomic dysreflexia is not caused by CNS depression and is limited to clients with spinal cord injuries.

Format: Multiple Choice Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 451, Opioid Agonists 26. A postsurgical client has been receiving morphine by patient-controlled analgesic for 2 days. What action by the nurse best addresses potential adverse effects? A) administering a stool softener as prescribed B) auscultating the client’s lung for adventitious sounds C) encouraging active range of motion exercises D) applying calf compressors as prescribed

Ans: A

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Feedback: Narcotics create a significant risk for constipation, and relevant nursing interventions are required. Respiratory rate must be closely monitored, but there is not a high likelihood of adventitious lung sounds. There is no obvious risk for venous stasis that would require calf compressors. Exercises have general benefits but do not address the particular adverse effects of morphine.

Format: Multiple Selection Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 451, Opioid Agonists; 451, Box 26.1 Focus on Drug Therapy across the Lifespan 27. A client who is 84 years old is experiencing chronic lower back that has not responded to NSAIDs. The provider has prescribed a transdermal fentanyl patch. What should the nurse do to ensure safe and effective care? Select all that apply. A) Monitor the client’s respiratory status closely. B) Keep the client’s bed in the lowest position. C) Ensure that the client has access to the call light. D) Monitor the client’s temperature before and after administration. E) Avoid administering any other medications while the transdermal patch is in place.

Ans: A, B, C

Feedback: Older clients are more likely to experience the adverse effects associated with these drugs, including respiratory depression and general CNS depression. To prevent falls, the client’s bed should be kept in a low position and the client should have ready access to the call light. There is no need to monitor temperature closely when

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narcotics are given. Other medications are not contraindicated when a fentanyl patch is in place.

Format: Multiple Choice Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 458, Contraindications and Cautions 28. What is the advantage of nalbuphine related to the neonate? A) results in short-term exposure B) presence of no risk of respiratory depression C) does not pass into breast milk D) presence of only a moderate risk for dependency

Ans: A

Feedback: Nalbuphine can be used to relieve pain during labor and birth, which provides short-term exposure to the fetus with little or no risk of dependency. These medications should be used during pregnancy only if the benefit to the parent clearly outweighs the risk to the fetus because of potential adverse effects on the neonate, including respiratory depression. They are known to enter human milk and should be used with caution during lactation because of the potential for adverse effects on the baby.

Format: Multiple Choice Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 451, Box 26.1 Focus on Drug Therapy across the Lifespan 29. The client in labor receives morphine every 2 hours to manage labor pain. After 22 hours of labor, the client delivers a healthy neonate. What is the nurse’s priority action related to the newborn? A) Monitor for opioid effects. B) Administer naloxone. C) Monitor for withdrawal syndrome. D) Assess for congenital anomaly.

Ans: A

Feedback: Morphine, meperidine, and oxymorphone are often used for analgesia during labor. The mother should be monitored closely for adverse reactions, and, if the drug is used during a prolonged labor, the newborn infant should be monitored for opioid effects. Naloxone would only be given if the newborn displays opioid effects. Withdrawal syndrome would not be seen with less than 24 hours of use. Every newborn is assessed for congenital anomalies, but this would not be related to administration of morphine to the mother and so would not be the highest priority.

Format: Multiple Choice Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 450, Opioids 30. What client characteristic may contraindicate the use of tramadol for the treatment of a client’s pain following traumatic injuries?

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A) The client has developed a wound infection and is at risk of sepsis. B) The client is 48 hours postorthopedic surgery. C) The client has a history of crack cocaine addiction. D) The client required a transfusion of packed red blood cells on admission.

Ans: C

Feedback: The use of tramadol is generally limited in clients who have a history of addiction. Infection, surgery, and transfusions would not necessarily preclude the use of this narcotic.

Format: Multiple Selection Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 460, Opioid Antagonists 31. The client is brought to the emergency department in respiratory arrest after overdosing on heroin. The person accompanying the client says that the client has been using heroin for years. After being administered one dose of naloxone, the client begins to breathe spontaneously but remains nonresponsive to stimuli, so another dose is prescribed. The nurse should monitor for what sign(s) and symptom(s) of acute narcotic abstinence syndrome? Select all that apply. A) tachycardia B) hypertension C) vomiting D) bradypnea E) sedation

Ans: A, B, C

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Feedback: The most common adverse effect is an acute narcotic abstinence syndrome that is characterized by nausea, vomiting, sweating, tachycardia, hypertension, tremulousness, and feelings of anxiety. Bradypnea and sedation are not associated with acute narcotic abstinence syndrome.

Format: Multiple Choice Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 450, Opioids 32. What order for naloxone would be appropriate for the nurse to administer for reversal of opioid effects? A) 1 mg IV repeat every 2 to 3 minutes B) 5 mg IV repeat every 5 minutes C) 0.1 mg IV repeat every 2 to 3 minutes D) 0.4 mg IV repeat every 3 minutes

Ans: C

Feedback: 0.1 to 0.2 mg is given IV and then repeated every 2 to 3 minutes for reversal of opioid effects. If the client has overdosed on opioids, the dose would be much larger: 0.4 to 2 mg every 2 to 3 minutes.

Format: Fill-in-the-Blank Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 451, Opioid Agonists 33. A hospital client is reporting pain, and the provider has prescribed 3 mg hydromorphone SC. The medication is available in single-use vials of 10 mg/1 mL. How many milliliter of hydromorphone should the nurse draw up? Record your answer to the nearest tenth.

Ans: 0.3 mL

Feedback: The nurse should divide 3 mg by 10 mg/mL, resulting in 0.3 mL.

Format: Multiple Choice Chapter: 26 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 462, Box 26.6 Focus on Drug Therapy across the Lifespan: Antimigraine Agents 34. In order for rizatriptan to be prescribed for a child, what criteria must be met? A) At least 6 years of age B) No history of respiratory disease C) A history of genetic disorder D) At least 12 years of age

Ans: A

Feedback: Rizatriptan can be prescribed to children 6 years and older. None of the other options reflect an appropriate criterion.

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Test Generator Questions, Chapter 27, General and Local Anesthetic Agents Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 473, General Anesthesia 1. A client is preoperative, and there is a need to decrease the client’s sympathetic stimulation to ensure that the client does not remember the procedure. The nurse should anticipate the use of what type of agent? A) antihistamine B) antiemetic C) opioid agonist D) sedative–hypnotic

Ans: D

Feedback: Sedative–hypnotics relax the client, facilitate amnesia, and decrease sympathetic stimulation. Antihistamines decrease the chance of allergic reaction and help dry secretions. Antiemetics decrease the nausea and vomiting associated with gastrointestinal (GI) depression. Narcotics (opioid agonists) aid in the analgesic and sedative effects.

Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 1, 6 Page and Header: 473, General Anesthesia 2. The perioperative nurse is caring for a surgical client whose skeletal muscles are relaxed, whose respirations are 20 breaths/min, and whose pupils are dilated. In what stage of anesthesia is this client? A) stage 1: analgesia stage B) stage 2: excitement stage C) stage 3: surgical anesthesia stage D) stage 4: medullary paralysis

Ans: C

Feedback: Stage 3 is surgical anesthesia, which involves relaxation of skeletal muscles and return of regular respirations. During this stage, eye reflexes and pupil dilation are progressively lost. Surgery can be safely performed in this stage. Stage 1 refers to the loss of pain sensation; stage 2 involves a period of excitement with sympathetic stimulation (e.g., tachycardia, increased respirations, blood pressure changes); and stage 4 involves deep central nervous system depression with loss of respiratory and vasomotor center stimuli. Death can occur rapidly at this stage if adequate support is not supplied.

Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 6

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Page and Header: 478, Nursing Considerations for Patients Receiving General Anesthetic Agents 3. The nurse is developing a plan of care for a client whose scheduled surgery will last approximately 3 hours. What intraoperative nursing conclusion should the nurse prioritize? A) impaired swallowing related to intubation and mechanical ventilation B) risk for deficient fluid volume related to absence of oral intake C) acute pain related to disruption of tissue during surgery D) risk for impaired skin integrity related to immobility

Ans: D

Feedback: The client would need to be moved or turned periodically to prevent skin breakdown and the formation of decubitus ulcers. The client’s risk for pain is addressed by the anesthesiologist through the administration of general anesthesia. The client’s absence of swallowing is expected during general anesthesia. The nurse is not primarily responsible for monitoring the client’s fluid balance during surgery.

Format: Multiple Choice Chapter: 27 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 478, Nursing Considerations for Patients Receiving General Anesthetic Agents 4. The perioperative nurse has created a plan of care for a surgical client. What nursing conclusion should the nurse include that is directly related to safety during surgery? A) deficient knowledge regarding drug therapy B) acute confusion related to anesthesia C) risk for powerlessness related to loss of consciousness

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D) risk for injury related to central nervous system (CNS) depressive effects of drugs

Ans: D

Feedback: The nursing conclusion, which directly relates to safety, is high risk for injury. Knowledge and powerlessness are psychosocial diagnoses that do not apply during general anesthesia. By definition, a client cannot be confused while under general anesthetic.

Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 483, Nursing Considerations for Patients Receiving Local Anesthetic Agents 5. The nurse is providing care for a client who is recovering from spinal anesthesia. What action by the nurse will best reduce the client’s risk for headache during recovery? A) Administer sumatriptan 50 mg sublingual, as prescribed. B) Administer morphine 2 to 4 mg IV, as prescribed. C) Maintain the client in the supine position. D) Place the client in Trendelenburg position for up to 1 hour.

Ans: C

Feedback: Clients receiving spinal anesthesia should remain in a recumbent position for as long as 12 hours. Triptan would not be effective because it is indicated for treatment of migraine headaches. Morphine would treat the headache but would not prevent it. Trendelenburg positioning is contraindicated.

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Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 475, Barbiturate Anesthetics 6. The postsurgical client appears to be awake but is in fact unconscious and has no response to painful stimuli. What nonbarbiturate anesthetic might the client have received? A) methohexital B) midazolam C) ketamine D) propofol

Ans: C

Feedback: Ketamine has been associated with a bizarre state of unconsciousness in which the client appears to be awake but is unconscious and cannot feel pain. This drug, which causes sympathetic stimulation with increase in blood pressure and heart rate, may be helpful in situations when cardiac depression is dangerous. Methohexital is a barbiturate anesthetic. Midazolam and propofol are nonbarbiturate anesthetics. None of these medications have this type of effect.

Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process

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Objective: 3, 6 Page and Header: 477, Anesthetic Gases 7. A client with a history of cirrhosis and type 2 diabetes is scheduled for surgery, and the care team is considering the use of nitrous oxide. What principle should guide the team’s actions? A) The client will likely have a delayed onset and extended duration of action. B) Oral hypoglycemics should be held for at least 24 hours prior to administration of nitrous oxide. C) The pharmacokinetics of nitrous oxide will not be affected by the client’s medical history. D) Nitrous oxide is contraindicated in clients who have active liver disease.

Ans: C

Feedback: Nitrous oxide is not metabolized, so liver function is not an important variable related to its use. There is no obvious reason why diabetes would contraindicate the use of nitrous oxide, and there is no need to withhold hypoglycemics.

Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 473, Box 27.1 Focus on Drug Therapy Across the Lifespan: Anesthetic Agents 8. The operating room nurse is developing the care plan for a distraught and combative 4-year-old child scheduled for removal of a foreign body from the sinus cavity. The nurse should anticipate the administration of what anesthetic? A) ketamine B) propofol

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C) lidocaine D) bupivacaine

Ans: B

Feedback: Propofol is widely used for diagnostic tests and short procedures in children older than 3 years of age because of its rapid onset and metabolism and generally smooth recovery. Ketamine has a high risk for adverse effects. Lidocaine and bupivacaine provide local anesthesia, but this child would likely require short-acting general anesthetic.

Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 473, General Anesthesia 9. A client is positioned on the operating room table in preparation for knee surgery. After the anesthesiologist begins anesthesia, what is the next phase of anesthesia? A) induction B) maintenance C) recovery D) medullary paralysis

Ans: B

Feedback: Induction is the period from the beginning of anesthesia until stage 3, or surgical anesthesia, is reached. After induction comes the maintenance phase from stage 3 until the surgical procedure is complete. A slower, more predictable anesthetic, such as a gas anesthetic, may be used to maintain the anesthesia after the client is in stage

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3. This is followed by the recovery period that begins with the discontinuation of anesthesia. Medullary paralysis is the depth of anesthesia known as stage 4.

Format: Multiple Choice Chapter: 27 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 4 Page and Header: 483, Nursing Considerations for Patients Receiving Local Anesthetic Agents: Assessment: History and Examination 10. The nurse is collecting a nursing history from a preoperative client who is to receive local anesthesia. While taking the admission history, the client reports an allergy to lidocaine. What is the nurse’s priority action? A) Notify the anesthesiologist. B) Cancel the surgery. C) Notify the surgeon. D) Tell the perioperative nurse.

Ans: A

Feedback: The priority action is to inform the anesthesiologist who will administer the anesthetic because local anesthesia often involves use of lidocaine. It is not within the nurse’s scope of practice to cancel surgery. Notifying the surgeon and the perioperative nurse is appropriate but is not the priority of care.

Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 473, General Anesthesia 11. The nurse is caring for a client who is in stage 2 of general anesthesia. What is the nurse’s priority intervention for this client? A) Reassure the client. B) Restrain the client. C) Provide eye care. D) Reposition the client.

Ans: A

Feedback: Stage 2, the excitement stage, is a transitional period of excitement and often combative behavior, with many signs of sympathetic stimulation (e.g., tachycardia, increased respirations, blood pressure changes). Providing reassurance can protect the client during the transition to surgical anesthesia. Eye care and repositioning are important in stages 3 and 4. It would be inappropriate to restrain the client and would likely exacerbate the client’s sympathetic stimulation.

Format: Multiple Choice Chapter: 27 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 476, Nonbarbiturate Anesthetics 12. The client received midazolam in combination with an inhaled anesthetic and a narcotic during surgery. The postanesthesia care unit (PACU) nurse anticipates this combination of drugs will have what effect on the plan of care? A) The client will likely require a naloxone infusion. B) The client will likely need extended time in the unit.

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C) The client will require close monitoring for medullary paralysis. D) The client will need to be kept NPO for at least 18 hours.

Ans: B

Feedback: Midazolam is associated with increased toxicity and length of recovery when used in combination with inhaled anesthetics, other central nervous system depressants, narcotics, propofol, or thiopental. Because this client received both narcotics and inhaled anesthetics, the nurse will anticipate this client’s time in the PACU will be extended. Naloxone would be administered if the client received excessive narcotics resulting in respiratory depression. Medullary paralysis is an emergency that would more likely occur in the operating room. The client will be kept NPO until the risk of aspiration is negligible, but this would not be expected to take 18 hours.

Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 480, Local Anesthesia 13. The nurse is caring for a client who is in the emergency department with a 2-inch (5cm) laceration to the left arm caused by broken glass. The nurse suspects the local anesthetic will be administered by what method? A) topical administration B) infiltration C) field block D) nerve block

Ans: B

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Feedback: Infiltration local anesthesia involves injecting the anesthetic directly into the tissues to be treated (e.g., sutured, drilled, cut). This injection brings the anesthetic into contact with the nerve endings in the area and prevents them from transmitting nerve impulses to the brain. Topical administration would not be absorbed deeply enough to prevent pain. Field block would be used in a larger area (e.g., the entire area required surgical repair). Nerve block would anesthetize a far larger area than is required for 2inch laceration.

Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 475, Barbiturate Anesthetics 14. The postanesthesia care unit (PACU) nurse is caring for a client who received methohexital as an anesthetic agent during surgery. What action should the nurse perform to best address the likely adverse effects of anesthesia? A) Teach the client how to perform deep breathing and coughing exercises. B) Position the client in a semi-Fowler’s position, if tolerated. C) Position the client in a high Fowler’s position, if tolerated. D) Ensure that an emesis basin is readily available.

Ans: D

Feedback: Nausea and vomiting after recovery from methohexital are common; the nurse should prepare for this by having an emesis basin at hand. Upright positioning is not indicated during recovery, and client education is unlikely to be effective during recovery.

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Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 480, Nerve Block 15. For what client would the administration of an epidural block be most appropriate? A) a client who requires suturing of a laceration on the palm of the hand B) a client who is in the second stage of labor C) a client who requires neurosurgery for the removal of a brain tumor D) a client needing closed reduction of the right humerus

Ans: B Feedback: Nerve block is a method of administering local anesthesia by injecting the anesthetic at some point along the nerve or nerves that run to and from the region in which the loss of pain sensation or muscle paralysis is desired. Several types of nerve blocks are possible. Epidural anesthesia is an injection of the drug into the epidural space where the nerves emerge from the spinal cord. Its use is common during labor and birth. Brain surgery would require general anesthesia. Closed reduction of the right humerus would not be performed using a local anesthetic, and an epidural would not be used for orthopedic surgery. A laceration would be likely anesthetized using infiltration.

Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4, 6 Page and Header: 478, Nursing Considerations for Patients Receiving General Anesthetic

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Agents: Assessment: History and Examination 16. The operating room nurse is taking a client into the operating room when the client says that their grandmother almost died from a high fever in surgery 15 years ago. What is the nurse’s best initial action? A) Ensure that cooling blankets are available in the operating room. B) Immediately ensure that the anesthesiologist is aware of this. C) Monitor the client’s temperature closely during induction and maintenance of anesthesia. D) Document the client’s statement in the health record promptly.

Ans: B

Feedback: The nurse assesses for a personal or family history of malignant hyperthermia, which may be triggered by the use of general anesthetics. Identifying clients at risk is imperative because the mortality rate is very high. Consequently, it is a priority for the nurse to ensure that the client has told the anesthesiologist this fact. Documentation is necessary but does not ensure that this is communicated promptly. Monitoring the client and ensuring access to cooling blankets are insufficient responses.

Format: Multiple Selection Chapter: 27 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 6 Page and Header: 480, Local Anesthetic Agents 17. The circulating nurse in the day surgery center is caring for a client who is to receive a local anesthetic. When monitoring for adverse effects, what assessment(s) should the nurse perform? Select all that apply. A) temperature B) lung auscultation

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C) assessment for dizziness D) blood pressure E) assessment for nausea

Ans: C, D, E

Feedback: Adverse effects of local anesthetics are associated with the route of administration and the amount of drug that is absorbed systemically. These effects are related to the blockade of nerve depolarization throughout the system. Effects that may occur include central nervous system effects such as headache (especially with epidural and spinal anesthesia), restlessness, anxiety, dizziness, tremors, blurred vision, and backache; gastrointestinal (GI) effects such as nausea and vomiting; cardiovascular effects such as peripheral vasodilation, myocardial depression, arrhythmias, and blood pressure changes, all of which may lead to fatal cardiac arrest; and respiratory arrest. The client’s temperature is unlikely to be affected. Reduced respiratory rate may occur, but adventitious lung sounds would be unlikely.

Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Communication and Documentation Objective: 5, 6 Page and Header: 480, Local Anesthetic Agents 18. The client has just received IM lidocaine as a local anesthetic before insertion of a chest tube. After the administration of the lidocaine, the client tells the nurse, “It’s starting to feel numb. How long will this last?” What is the nurse’s best response? A) “Likely until the end of your procedure.” B) “Probably half-an-hour to 45 minutes.” C) “Likely around 2 hours.” D) “It’s very hard to say, since everyone’s body responds differently.”

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Ans: C

Feedback: The onset of intramuscular lidocaine is 5 to 10 minutes, peaks within 5 to 15 minutes, and the duration of action is 2 hours. The client would feel numb far later than the completion of the procedure. Drug responses certainly differ, but this should not stop the nurse from answering the client’s question. Format: Multiple Selection Chapter: 27 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 473, General Anesthesia 19. A nurse is explaining the concept of balanced anesthesia to a preoperative client. The nurse should describe the possible use of what drug(s)? Select all that apply. A) neuromuscular junction blockers B) narcotics C) atypical antipsychotics D) sedative–hypnotics E) nonsteroidal antiinflammatory drugs (NSAIDs)

Ans: A, B, D

Feedback: Balanced anesthesia involves giving a variety of drugs with specific effects to achieve analgesia, relax muscles, and invoke unconsciousness and amnesia. Classification of drugs administered includes sedative–hypnotics, neuromuscular junction blockers, and narcotics. Balanced anesthesia does not include use of antipsychotics or nonsteroidal antiinflammatory drugs.

Format: Multiple Choice

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Chapter: 27 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 473, Box 27.1 Focus on Drug Therapy Across the Lifespan: Anesthetic Agents: Children 20. A 5-year-old child has been admitted to the emergency department after stepping on a piece of glass. The care team that sutures will likely be necessary. What principle should guide the administration of anesthesia to this client? A) General anesthesia is preferred over local anesthesia for clients under 10 years. B) Local anesthetics may be applied topically but cannot be injected. C) Propofol is used in children over 3 years of age. D) Methohexital is the general anesthetic of choice.

Ans: C

Feedback: Propofol is widely used for diagnostic tests and short procedures in children older than 3 years of age because of its rapid onset and metabolism and generally smooth recovery. Methohexital is not the preferred general anesthetic. As with all clients, local anesthesia presents fewer risks than general anesthesia. Injection of local anesthetics is a safe and approved practice.

Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 478, Volatile Liquids

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21. A 54-year-old client diagnosed with chronic obstructive pulmonary disease is admitted for emergency surgery. What anesthetic agent would be dangerous to use on this client? A) enflurane B) desflurane C) sevoflurane D) isoflurane

Ans: B

Feedback: Desflurane use should be avoided in clients with respiratory problems and in those with increased sensitivity because of its irritation to the airways and tendency to cause respiratory depression. The other options have far fewer respiratory adverse effects and would be safer for use in this client.

Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 478, Nursing Considerations for Patients Receiving General Anesthetic Agents: Assessment: History and Examination 22. The nurse is admitting an adult client to the preoperative unit in preparation for an elective inguinal hernia repair procedure to be performed under general anesthesia. What is the nurse’s initial priority nursing assessment related to the anesthesia? A) Assess the client’s expectations for recovery. B) Assess the client’s veins for ideal intravenous access sites. C) Assess the client’s apical heart rate and rhythm. D) Assess the client’s weight.

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Ans: D

Feedback: Weighing the client is an initial priority because their weight will be used to determine appropriate dosing of all medications and will establish a baseline used for evaluation of any potential adverse effects. The other options are all actions the nurse will need to perform, but none are of higher priority than weighing the client with regard to anesthesia.

Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 2 Page and Header: 480, Local Anesthesia 23. The nurse is assessing a client prior to the client’s scheduled tooth extraction. The client is anxious about the possibility of pain during the procedure. What description of the anesthesia should the nurse provide? A) “A potent anesthetic will be rubbed on your gums and it will penetrate deeply within the next half hour.” B) “An anesthetic will be injected into the skin directly surrounding your tooth.” C) “An anesthetic will be injected to all of the nerves that are near your tooth.” D) “An anesthetic will be injected into the main nerve that links to your jaw and mouth.”

Ans: C

Feedback: Field block local anesthesia involves injecting the anesthetic all around the area that will be affected by the procedure or surgery. This is more intense than infiltration anesthesia because the anesthetic agent comes in contact with all of the nerve endings surrounding the area. This type of block is often used for tooth extractions. Topical would not be appropriate because it would not absorb deeply enough

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to block pain impulses in the root of the tooth. Nerve block would not be possible for oral surgery.

Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 475, Barbiturate Anesthetics 24. The nurse receives a client into the postanesthesia care unit who has had surgery using the anesthetic agent methohexital. The nurse anticipates the client’s need for what in the postoperative period? A) assistance in maintaining respirations B) assistance in moving lower extremities C) positioning in a semi-Fowler’s position D) analgesia to control the client’s pain

Ans: D

Feedback: Methohexital lacks analgesic properties, so the client may require postoperative analgesics to control pain. The client who has surgery under methohexital does not generally require assistance in maintaining respirations or assistance in moving their lower extremities. They also do not generally require positioning in a semi-Fowler’s position.

Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand

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Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 5 Page and Header: 480, Local Anesthetic Agents 25. The nurse in an ambulatory unit is reviewing the use of local anesthetic agents. What should the nurse determine is the differentiate factor between the local anesthetic agents lidocaine and procaine? A) Lidocaine is an amide that is broken down slowly, and this can lead to toxicity. B) Lidocaine is an ester that cannot become toxic in the system because of rapid metabolism. C) Procaine is an amide that is broken down immediately in the tissues. D) Procaine is metabolized by the liver with risk of toxicity and is classified as an ester.

Ans: A

Feedback: The ester local anesthetics are broken down immediately in the plasma by enzymes known as plasma esterases. The amide local anesthetics are metabolized more slowly in the liver. Serum levels of these drugs can become elevated and lead to toxicity. Lidocaine is an amide, and procaine is an ester.

Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5, 6 Page and Header: 477, Anesthetic Gases 26. What client is most likely to require the least time in recovery from anesthesia? A) a client whose surgery required the administration of propofol B) a client who had a cholecystectomy using balanced anesthesia C) a client who had oral surgery using nitrous oxide

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D) a pediatric client who had surgery using sevoflurane

Ans: C

Feedback: Nitrous oxide is a potent analgesic; it is used frequently for dental surgery because it does not cause muscle relaxation. It moves quickly in and out of the body so duration of action is short and recovery after dental work is quick. Propofol, sevoflurane, and the combinations that constitute balanced anesthesia would require much more extensive recovery.

Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 479, Nursing Considerations for Patients Receiving General Anesthetic Agents: Evaluation 27. The nurse is admitting a client to the postanesthesia care unit (PACU) who received general anesthesia for the removal of a bunion. The nurse should prioritize what assessments? A) lung auscultation and apical heart rate B) respirations and airway C) pain and temperature D) skin integrity and peripheral perfusion

Ans: B Feedback: Postanesthetic recovery requires frequent, comprehensive assessments including all of the listed parameters. Among the priority assessments, however, are the client’s airway patency and respiratory status. This is because both are heavily influenced by anesthesia and have rapid, serious consequences if disrupted.

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Format: Multiple Selection Chapter: 27 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching and Learning Objective: 3, 6 Page and Header: 482, Box 27.2 Focus on Safe Medication Administration: Examples of Combination Local Anesthetics 28. What factor is a significant contributor to the amount of effect expected of a dermal analgesia application? Select all that apply. A) age of the client B) amount of time application is left on the skin C) size of the area of application D) weight of the client E) nature of procedure being performed

Ans: B, C

Feedback: The amount of medication systemically absorbed, and consequently the amount of effect, is related to the duration of the application and the area to which it is applied. The other option should be considered but none have the significance of duration and size of the application.

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Objective: 3 Page and Header: 475, Barbiturate Anesthetics 29. The nurse is caring for a client scheduled for surgery who is to receive methohexital as part of the planned balanced anesthesia. What drug(s), if taken by the client, could result in a clinically important drug–drug interaction with the barbiturate? Select all that apply. A) levothyroxine B) ibuprofen C) propranolol D) theophylline E) warfarin

Ans: C, D, E

Feedback: Caution must be used when these drugs are used with any other central nervous system suppressants. Barbiturates can cause decreased effectiveness of theophylline, oral anticoagulants (e.g., warfarin), beta-blockers (e.g., propranolol), corticosteroids, hormonal contraceptives, phenylbutazones, metronidazole, quinidine, and carbamazepine. Thyroid hormone and ibuprofen have no known drug interactions with barbiturates.

Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 1, 6 Page and Header: 478, Volatile Liquids 30. The nurse is caring for an intraoperative client whose temperature has increased suddenly to 103.2°F (39.6°C). What intervention should the nurse anticipate? A) administration of midazolam

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B) administration of dantrolene C) administration of naloxone D) application of a cooling blanket

Ans: B

Feedback: Dantrolene is the preferred treatment for malignant hyperthermia and should always be readily available whenever anesthetics are used that could trigger the syndrome. Midazolam is a nonbarbiturate anesthetic, and naloxone is used to treat opioid overdoses. A cooling blanket will not adequately treat the client’s hyperthermia.

Format: Multiple Selection Chapter: 27 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 476, Nonbarbiturate Anesthetics 31. The nurse is caring for a client presenting with a dysrhythmia and who will undergo cardioversion this morning. The client will receive propofol as anesthetic during the procedure. What are the benefit(s) of using propofol for this procedure? Select all that apply. A) It has a very rapid clearance. B) It produces less of a hangover effect. C) It allows for quick recovery from anesthesia. D) Its onset of action is 5 minutes. E) It is painless to inject intravenously.

Ans: A, B, C

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Feedback: Propofol often is used for short procedures because it has a very rapid clearance and produces much less of a hangover effect and allows for quick recovery. It is a very short-acting anesthetic with a rapid onset of action of 30 to 60 seconds. Propofol often causes local burning on injection.

Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 473, Box 27.1 Focus on Drug Therapy Across the Lifespan: Anesthetic Agents: Children 32. Whenever possible, the IV nurse at the hospital applies a topical anesthetic to reduce sensation at the site while inserting IV cannulas. What client is at greatest risk for systemic absorption of the topical anesthetic? A) a 79-year-old client with poor skin turgor B) a 4-day-old neonate C) a 40-year-old client with liver disease D) a client who is immunocompromised

Ans: B Feedback: When topically applying a local anesthetic, it is important to remember that there is greater risk of systemic absorption and toxicity with infants. Tight diapers can act like occlusive dressings and increase systemic absorption. Liver disease and reduced immunity do not affect topical absorption.

Format: Multiple Choice Chapter: 27 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 473, Box 27.1 Focus on Drug Therapy Across the Lifespan: Anesthetic Agents: Older Adults 33. What intervention is particularly important to implement when providing an older adult client who is recovering from gall bladder surgery with postanesthesia care? A) medicating for postoperative pain B) encouraging coughing with deep breathing C) early ambulation around the room D) monitoring vital signs

Ans: B

Feedback: After general anesthesia, it is important to promote vigorous pulmonary hygiene to decrease the risk of pneumonia. While the remaining options are appropriate, the older adult’s increased risk for pneumonia makes coughing and deep breathing the priority.

Test Generator Questions, Chapter 28, Neuromuscular Junction Blocking Agents Format: Multiple Choice Chapter: 28 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 1 Page and Header: 489, The Neuromuscular Junction

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1. A client is repositioning independently, an action that involves multiple muscle contractions. According to the sliding filament theory, what action occurs first during muscle contraction? A) Troponin is freed and prevents actin and myosin from reacting with each other. B) Calcium binds to troponin, which causes the release of actin and myosin-binding sites. C) Actin and myosin molecules react with each other sliding along the filament and making it shorter. D) Muscle filament relaxes or slides back to the resting position.

Ans: B

Feedback: With stimulation, depolarization allows the release of calcium ions, stored in tubules, into the cell. The calcium binds to troponin, a chemical found throughout the sarcomere. This binding of troponin releases the actin- and myosin-binding sites, allowing them to react with each other. As the calcium is removed from the cell during repolarization of the muscle membrane, the troponin is freed and once again prevents the actin and myosin from reacting with each other. The muscle filament then relaxes or slides back to the resting position.

Format: Multiple Choice Chapter: 28 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 489, The Neuromuscular Junction 2. A client has a progressive neuromuscular disorder that causes muscle weakness. A deficiency of what neurotransmitter would be most likely to cause this client’s symptoms? A) acetylcholine B) serotonin C) D-gluconamidoethyl methacrylate (GAMA)

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D) epinephrine

Ans: A

Feedback: At the acetylcholine receptor site on the effector’s side of the synapse, the acetylcholine interacts with the nicotinic cholinergic receptors causing the depolarization, eventually resulting in muscle contraction. Serotonin, GAMA, and epinephrine are not part of muscle contraction and relaxation.

Format: Multiple Choice Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 2, 5 Page and Header: 493, Depolarizing Neuromuscular Junction Blocker 3. The nurse, working in the preoperative area, is caring for a 65-year-old client who is scheduled to receive succinylcholine as part of general anesthesia. When collecting the nursing history, what finding should require the nurse to notify the anesthesiologist? A) The client has type 2 diabetes, controlled with diet and exercise. B) The client donated blood 7 weeks ago. C) The client takes vitamin B6 supplements on a regular basis. D) The client takes timolol eye drops to treat narrow-angle glaucoma.

Ans: D

Feedback: Succinylcholine should be used with caution in clients with narrow-angle glaucoma because intraocular pressure increases. The client’s recent blood donation, diabetes, or vitamin supplements would not have a direct bearing on the safe and effective use of succinylcholine.

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Format: Multiple Choice Chapter: 28 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 493, Depolarizing Neuromuscular Junction Blocker; 493, Box 28.2 4. The nurse in the postanesthesia care unit (PACU) cares for many clients who receive succinylcholine during surgery. The nurse should expect which client to spend more time in the postanesthesia care unit due to prolonged paralysis and delayed return of spontaneous ventilation? A) an adult client who is obese B) a middle-aged client with a family history of low plasma cholinesterase C) a Native American client with peripheral vascular disease D) an adult client who is a frequent user of marijuana

Ans: B

Feedback: Belonging to a genetic group that is predisposed to low plasma cholinesterase levels makes a person more susceptible to prolonged paralysis after succinylcholine use. Obesity, marijuana use, and Native American ethnicity do not increase these risks to the same extent.

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Page and Header: 490, Nondepolarizing Neuromuscular Junction Blockers; 490, Table 28.1 5. A client is having outpatient surgery that should last only 45 minutes. The client is planning to go home as soon as possible after the surgery is complete. What nondepolarizing neuromuscular junction blocker will most likely be used as an adjunct therapy to general anesthesia for this client? A) atracurium B) cisatracurium C) pancuronium D) rocuronium

Ans: D

Feedback: Rocuronium has a rapid onset of action and a short duration, making it a drug of choice for outclient surgical procedures when the client will be leaving to go home and will need to be awake, alert, and mobile. Atracurium, cisatracurium, and pancuronium are associated with longer paralysis and recovery.

Format: Multiple Choice Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 490, Nondepolarizing Neuromuscular Junction Blockers 6. A client is taking aminophylline for their chronic obstructive pulmonary disease. The client is about to undergo emergency surgery and will receive a neuromuscular junction (NMJ) blocker as part of the procedure. What is the nurse’s best action? A) Make sure that the client receives the aminophylline as normally scheduled to maintain therapeutic levels.

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B) Monitor the client closely for signs of early arousal and early return of muscle function. C) Carefully explain all that will take place during the procedure because the client will be unable to talk. D) After obtaining a prescription from the provider, switch the client to theophyllines before the procedure begins.

Ans: B

Feedback: Aminophylline can cause a decreased effectiveness of NMJ blockers, leading to reduced paralysis and early return of movement. If a client has emergency surgery and has been taking aminophylline, the client should be carefully monitored for early arousal and return of movement. The client will not be awake during surgery using an NMJ blocker and will be intubated to ensure respirations. Aminophylline and other xanthine derivatives like the theophyllines will have the same effect.

Format: Multiple Choice Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 490, Table 28.1 Neuromuscular Junction (NMJ) Blockers 7. The nurse is caring for a client who is being maintained on mechanical ventilation following acute respiratory distress syndrome. Atracurium is being administered to limit the client’s resistance to mechanical ventilation. What is the nurse’s priority assessment? A) assessment for malignant hyperthermia B) temperature C) heart rate D) pain

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Ans: C

Feedback: Bradycardia is a common adverse effect associated with atracurium. This drug is not closely associated with malignant hyperthermia, which is a rare occurrence. Temperature would be among the lower-priority assessments. Pain would be a higher priority, since atracurium provides no analgesia; however, bradycardia would be the most acute risk to the client’s safety.

Format: Multiple Choice Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 490, Nondepolarizing Neuromuscular Junction Blockers 8. The nurse is preparing a client for surgery who will receive a neuromuscular junction blocker during the procedure. It is important for the nurse to review the client’s medication history for concurrent use of what class of medications? A) angiotensin-converting enzyme (ACE) inhibitors B) beta-blockers C) calcium channel blockers D) loop diuretics

Ans: C

Feedback: When calcium channel blockers are used concurrently with neuromuscular junction blockers, the client is at increased risk of prolonged paralysis. The dose of the neuromuscular junction blocker should be lowered if this combination cannot be avoided, and the client should be monitored closely. There is no anticipated drug–drug interaction with ACE inhibitors, beta-blockers, or loop diuretics.

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Format: Multiple Choice Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 491, Box 28.1 Focus on Drug Therapy Across the Lifespan: NMJ Blocking Agents: Older Adults 9. An older adult client will receive a neuromuscular junction blocker during surgery. The nurse should identify what nursing diagnosis when planning this client’s care? A) chronic pain B) risk for impaired skin integrity C) imbalanced nutrition: less than body requirements D) chronic confusion

Ans: B

Feedback: An older adult or frail client will need extra nursing care to prevent skin breakdown during the period of paralysis because skin tends to be thinner and more susceptible to breakdown. Therefore, risk of impaired skin integrity would be an appropriate nursing diagnosis. The client may be acutely confused when awakening, but there is no reason to think they would remain chronically confused if they were not before surgery. Similarly, surgical pain would not be expected to be chronic. The shortterm fasting that is required for surgery does not normally pose a significant threat to a client’s nutritional status.

Format: Multiple Selection Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 490, Nondepolarizing Neuromuscular Junction Blockers 10. For which client(s) would the use of a nondepolarizing neuromuscular junction (NMJ) blocker most likely be appropriate? Select all that apply. A) a presurgical client who requires endotracheal intubation B) an anxious client who requires sedation prior to administration of general anesthesia C) a client with major depression who will undergo electroconvulsive therapy D) a child who must remain still to allow the provider to suture a laceration E) a client with pneumonia who requires mechanical ventilation

Ans: A, C, E

Feedback: NMJ blockers are primarily used as adjuncts to general anesthesia, to facilitate endotracheal intubation, to facilitate mechanical ventilation, and to prevent injury during electroconvulsive therapy. NMJ blockers do not sedate a client, who will be paralyzed after administration but will remain alert unless another medication is given. Other, more conservative, forms of restraint would be used for a child who requires sutures.

Format: Multiple Choice Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 490, Nondepolarizing Neuromuscular Junction Blockers

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11. A surgical client will soon be administered a nondepolarizing neuromuscular junction blockers (NMJ) by the anesthesiologist. The nurse should recognize that this drug will inhibit the client’s muscular activity by what means? A) denaturing acetylcholine (ACh) molecules, preventing them from occupying Ach receptor sites B) occupying the muscular cholinergic receptor sites so stimulation cannot happen C) preventing the cholinergic receptor sites from recognizing ACh molecules D) enhancing the inhibitory effects of gamma-aminobutyric acid (GABA)

Ans: B

Feedback: Nondepolarizing NMJ blockers cause muscle paralysis by acting like ACh. They excite (depolarize) the muscle and prevent repolarization and further stimulation. They do not “denature” ACh molecules or inhibit recognition. NMJ blockers do not modify the action or quantity of GABA.

Format: Multiple Choice Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 2 Page and Header: 490, Nondepolarizing Neuromuscular Junction Blockers 12. A client is scheduled for surgery, and it is planned that the client will receive pancuronium as an adjunct to general anesthesia. What should the nurse teach the client about this medication? A) Shortly after administration, the drug will cause paralysis and loss of consciousness. B) The medication will be inhaled and will take effect within 30 seconds of the first inhalation. C) The client will be unable to move approximately 5 minutes after receiving the drug.

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D) The drug will cause the client’s muscles to remain flexed but immobile until the effects wear off.

Ans: C

Feedback: Pancuronium is administered intravenously, with an onset of 4 to 6 minutes. Like other NMJ blockers, it causes paralysis but not loss of consciousness. It causes flaccid, not spastic paralysis.

Format: Multiple Choice Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 490, Nondepolarizing Neuromuscular Junction Blockers 13. The nurse is caring for a client who is receiving pancuronium to facilitate mechanical ventilation. The anesthesiologist believes that the client has excessive neuromuscular blockade. What action should the nurse anticipate? A) administration of an anticholinergic B) administration of a dopaminergic C) administration of naloxone D) administration of a cholinesterase inhibitor

Ans: D

Feedback: Cholinesterase inhibitors can overcome excessive neuromuscular blockade caused by nondepolarizing NMJ blockers. Anticholinergics do not have this effect. Dopamine levels are unrelated to the pharmacokinetics of NMJ blockers. Naloxone reverses the effects of narcotics, not NMJ blockers.

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Format: Multiple Choice Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 490, Nondepolarizing Neuromuscular Junction Blockers; 490, Table 28.1 14. The nurse is caring for a presurgical client who is scheduled to receive rocuronium. What aspect of this client’s health status would warrant cautious use of this medication? A) The client has alcoholic liver disease. B) The client takes benzodiazepines. C) The client has benign prostatic hyperplasia (BPH). D) The client is 68 years old.

Ans: A

Feedback: Rocuronium must be used with caution in clients who have liver disease. The anesthesiologist would consider the client’s use of benzodiazepines, but this is less significant than the client’s hepatic impairment. The client’s age and history of BPH are not likely problematic.

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15. The postanesthesia care unit (PACU) nurse is caring for a client who had succinylcholine as an adjunct to anesthesia. What action best addresses the potential adverse effects of this medication? A) repositioning the client every 15 minutes, if possible B) ensuring dantrolene is readily available C) monitoring the client for signs and symptoms of increased intracranial pressure D) monitoring the client’s IV sites for extravasation

Ans: B

Feedback: Succinylcholine is more likely to cause malignant hyperthermia than other drugs, so it is very important that dantrolene be available. The nurse should frequently reposition the client, but this is unrelated to the adverse effects of succinylcholine. This drug is not closely associated with increased ICP or extravasation.

Format: Multiple Choice Chapter: 28 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 495, Nursing Considerations for Patients Receiving Neuromuscular Junction Blocking Agents: Nursing Conclusions 16. The nurse is providing preoperative teaching for a client who will have a thyroidectomy. The client tells the nurse about a recent documentary about anesthesia awareness (unintended intraoperative awareness) that the client describes as “harrowing.” What nursing diagnosis will the nurse include in this client’s plan of care? A) moral distress related to adverse effects of anesthesia B) deficient knowledge regarding drug therapy C) fear related to paralysis D) ineffective protection related to NMJ blockade

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Ans: C

Feedback: Nursing diagnoses related to drug therapy may include fear related to paralysis. This is corroborated by the client’s description of the documentary as “harrowing.” There is no indication of moral distress. The client’s description reveals fear more than lack of knowledge, though the nurse should dialogue with the client about this phenomenon. Ineffective protection is primarily associated with unsafe relationships.

Format: Multiple Selection Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 489, Neuromuscular Junction Blocking Agents 17. The nurse is caring for a client who is in the intensive care unit and has been receiving neuromuscular junction (NMJ) blockers, sedatives, and analgesics for the past 2 weeks. The NMJ blocker therapy has been discontinued, and the other medications are being reduced gradually now that the client is extubated. The family asks why the client cannot sustain normal respirations. What are appropriate response(s) by the nurse? Select all that apply. A) “Their muscles need to get their strength back again.” B) “This is a common occurrence in situations like this.” C) “They are likely to breathe better each day.” D) “The drugs created temporary muscle damage which has to heal.” E) “This is caused by weakened muscles, not by injury or disease.”

Ans: A, B, C, E

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Feedback: After 2 weeks of muscle paralysis, the muscles are weak and will take time to strengthen as the client begins using them again. Profound and prolonged muscle paralysis is always possible; clients must be supported until they are able to resume voluntary and involuntary muscle movement. When the respiratory muscles are paralyzed, depressed respiration, bronchospasm, and apnea are anticipated adverse effects, so the client will remain ventilated until they can demonstrate adequate respiratory effort. The drugs did not damage the muscle, but lack of use has weakened them.

Format: Multiple Choice Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 493, Depolarizing Neuromuscular Junction Blocker 18. The perioperative nurse is monitoring the status of a client who has just been given IV succinylcholine prior to surgery. In how long should the nurse expect to note an absence of movement? A) 30 to 60 seconds B) 2 to 3 minutes C) 5 to 10 minutes D) 12 to 15 minutes

Ans: A

Feedback: Succinylcholine has an onset of action of 30 to 60 seconds. The other options are incorrect.

Format: Multiple Choice

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Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 495, Nursing Considerations for Patients Receiving Neuromuscular Junction Blocking Agents: Nursing Conclusions 19. The client will be receiving succinylcholine during surgery. During preoperative teaching, the nurse should caution the client about what potential adverse effect that may be experienced after surgery? A) throat and back pain B) spinal headache C) generalized edema D) orange-tinted urine

Ans: A

Feedback: Succinylcholine is associated with back and muscle pain, related to the initial muscle contraction reaction. It does not cause a spinal headache, edema, or discolored urine.

Format: Multiple Choice Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 493, Depolarizing Neuromuscular Junction Blocker 20. A student asks the pharmacology instructor how succinylcholine differs from acetylcholine (ACh). What should the instructor respond?

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A) “Succinylcholine is not broken down instantly.” B) “It results in a prolonged contraction of the muscle.” C) “The muscle becomes hyperstimulated by succinylcholine.” D) “Succinylcholine’s duration of action is about 2 hours, unlike acetylcholine.”

Ans: A

Feedback: Unlike endogenous ACh, succinylcholine is not broken down instantly. Succinylcholine, a depolarizing NMJ blocker, attaches to the ACh receptor site on the muscle cell, causing a prolonged depolarization of the muscle. This depolarization causes stimulation of the muscle and muscle contraction (seen as twitching) and then as flaccid paralysis, so the contraction of the muscle is not prolonged, and the muscle is incapable of being stimulated. The duration of effects of succinylcholine is 4 to 6 minutes and not 2 hours.

Format: Multiple Choice Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Communication and Documentation Objective: 4 Page and Header: 493, Depolarizing Neuromuscular Junction Blocker 21. The certified registered nurse anesthetist documents the anesthesia plan as using a depolarizing neuromuscular junction (NMJ) blocker as adjunct to other anesthetics on the client when they go to surgery. The nurse would understand from this note that the client will receive what drug? A) rocuronium B) pancuronium C) succinylcholine D) cisatracurium

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Ans: C

Feedback: Currently, the only agent classified as a depolarizing NMJ blocker is succinylcholine. Rocuronium, pancuronium, and cisatracurium are all nondepolarizing NMJ blockers.

Format: Multiple Choice Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 495, Nursing Considerations for Patients Receiving Neuromuscular Junction Blocking Agents: Nursing Conclusions 22. The nurse is participating in the care of a pediatric client who received pancuronium for mechanical ventilation in the pediatric intensive care unit. What assessment should the nurse prioritize? A) deep tendon reflexes B) skin integrity C) pupillary response D) muscle strength

Ans: B Feedback: NMJ blockers all cause paralysis, which creates an acute risk for skin breakdown. This should be among the main nursing priorities of a client who is given these drugs. Skin integrity would be prioritized over pupillary response. Muscle strength and reflexes are expected to be absent while NMJ blockers are being administered.

Format: Multiple Choice Chapter: 28

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 490, Nondepolarizing Neuromuscular Junction Blockers 23. The nurse is caring for a client with long-standing schizophrenia who will begin a course of electroconvulsive therapy (ECT). The nurse is informed that the client will be given pancuronium before the procedure. What outcome best indicates therapeutic effects of pancuronium in this client? A) The client does not vomit during or after ECT. B) The client is pain-free before, during, and after ECT. C) The client has no memory of ECT being performed. D) The client is free of injury when ECT is complete.

Ans: D

Feedback: Pancuronium is used, in this case, to induce skeletal muscle relaxation and to reduce the intensity of muscle contractions in electroconvulsive therapy. Pancuronium has no analgesic or amnesic effects. It would not reduce the risk of aspiration unless an endotracheal tube was placed with the cuff inflated, and then, it would not be the drug that was preventing aspiration.

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24. A client is scheduled for a bowel resection that is expected to take approximately 3 hours and will be given atracurium in addition to balanced anesthesia. What assessment finding best indicates therapeutic effects of atracurium in this client? A) The client is immobile, with flaccid muscles. B) The client’s muscles are immobile, in a flexed position. C) The client’s muscles are immobile, with the exception of minor twitches. D) The client is immobile, with the exception of muscles under cranial nerve control.

Ans: A

Feedback: Flaccid paralysis is the expected outcome of NMJ blockers. Flexion rapidly gives way to flaccidity. This affects all muscles, including those under direct innervation of the cranial nerves.

Format: Multiple Choice Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 490, Nondepolarizing Neuromuscular Junction Blockers 25. The nurse is assessing a client who was given succinylcholine earlier in the day during a surgical procedure. What assessment finding would suggest to the nurse that the client experienced histamine release as a result of succinylcholine administration? A) The client has tenderness running the length of the spine. B) The client has an audible wheeze on inspiration. C) The client’s urine output in the 5 hours since surgery is 325 mL. D) The client reports numbness and tingling to their lips.

Ans: B

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Feedback: The histamine release associated with many of the depolarizing NMJ blockers can cause respiratory obstruction with wheezing and bronchospasm. This phenomenon would not influence urine output or cause pain or numbness.

Format: Multiple Choice Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 490, Nondepolarizing Neuromuscular Junction Blockers; 490, Table 28.1 26. The nurse is assisting the nurse practitioner who is preparing to intubate the client. The nurse practitioner has prescribed atracurium and midazolam, a short-acting benzodiazepine used to sedate the client. In what order will the client be given these medications? A) They can be given in any sequence, separated by at least 2 minutes. B) Give the midazolam first and then atracurium a few moments later. C) Give atracurium and then give midazolam a few moments later. D) Give the midazolam, then a 250 mL normal saline bolus, and then atracurium.

Ans: B

Feedback: Atracurium induces muscular paralysis resulting in the inability to breath due to paralysis of respiratory muscles, but it has no impact on perception of consciousness. Receiving this drug before being sedated would be frightening and extremely anxiety provoking for the client, so the sedative should be given first to reduce perception and consciousness before administering atracurium.

Format: Ordered Response

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Chapter: 28 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 1 Page and Header: 489, The Neuromuscular Junction 27. When a normal muscle functions, several actions take place. In what order do these physiological events occur? All options must be used. A Nerve impulse arrives at the motor nerve terminal. B ACh crosses the synaptic cleft. C ACh is broken down by acetylcholinesterase. D ACh interacts with the nicotinic cholinergic receptors. E The muscle membrane is depolarized. F Release of the neurotransmitter, ACh.

Ans: A, F, B, D, E, C

Feedback: Normal muscle function involves the arrival of a nerve impulse at the motor nerve terminal, followed by the release of the neurotransmitter, ACh, into the synaptic cleft. At the acetylcholine receptor site on the effector side of the synapse, ACh interacts with the nicotinic cholinergic receptors, causing depolarization of the muscle membrane. ACh is then broken down by acetylcholinesterase (an enzyme), freeing the receptor for further stimulation.

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Page and Header: 490, Table 28.1 Neuromuscular Junction (NMJ) Blockers 28. The client has been mechanically ventilated for the past week and is receiving a neuromuscular junction (NMJ) blocker, an analgesic, and a sedative. The goal is to extubate the client. The nurse should anticipate what action by the care team? A) discontinuing the NMJ blocker first B) discontinuing the sedative first C) discontinuing the analgesic first D) discontinuing all three medications simultaneously

Ans: A

Feedback: NMJ blockers have no effect on pain perception or consciousness and should not be used without sedation, so the NMJ blocker should be removed first. Because the client has been receiving analgesics for a week, they will have to be weaned off them to overcome dependence. Sedatives can be removed more quickly after the NMJ blocker’s effects are gone.

Ans: B

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Feedback: Myasthenia gravis contraindicates the use of NMJ blockers because blocking of the ACh cholinergic receptors aggravates the disease and increases the muscular effects. None of the client’s other characteristics would contraindicate the use of an NMJ blocker.

Format: Multiple Choice Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 495, Nursing Considerations for Patients Receiving Neuromuscular Junction Blocking Agents: Intervention with Rationale 30. A surgical client was administered a neuromuscular junction (NMJ) blocker in addition to balanced anesthesia. During the procedure, the anesthesiologist administers a cholinesterase inhibitor. The nurse should assess for what expected effect? A) return of voluntary movement B) absence of pain during recovery C) absence of nausea during recovery D) prolonged paralysis

Ans: A

Feedback: An cholinesterase inhibitor overcomes excessive neuromuscular blockade caused by nondepolarizing NMJ blockers. It would end paralysis and would not affect the client’s pain or nausea.

Format: Multiple Choice Chapter: 28

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Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 495, Nursing Considerations for Patients Receiving Neuromuscular Junction Blocking Agents: Intervention with Rationale 31. The operating room nurse is assisting with a client’s surgery, which is taking longer than anticipated. The anesthesiologist wishes to assess the client’s degree of neuromuscular blockade. What is the nurse’s best action? A) Obtain the peripheral nerve stimulator. B) Analyze the trend of the client’s vital signs. C) Assess the client’s response to painful stimuli. D) Assess the client’s response to hot and cold. Ans: A

Feedback: Have a peripheral nerve stimulator on standby to assess the degree of neuromuscular blockade, if appropriate. Vital signs can indicate degree of sedation and assess pain sensation, but they are not an indicator of the degree of neuromuscular blockade. Response to painful stimuli would be more of an indication of effects of sedation and/or analgesic than degree of muscular blockade. Any neuromuscular junction blockage would reduce or eliminate reflexes, so it would not be a means of assessing degree of blockage.

Format: Multiple Choice Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 493, Depolarizing Neuromuscular Junction Blocker

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32. The registered nurse anesthetist has administered a small dose of nondepolarizing neuromuscular junction (NMJ) blocker before administering succinylcholine. What outcome most clearly indicates therapeutic effect of this action? A) The client does not experience discomfort of depolarization of muscles. B) The client remains free of malignant hyperthermia. C) The client does not experience adverse effects of dantrolene. D) The duration of succinylcholine exceeds 60 minutes.

Ans: A

Feedback: Succinylcholine is associated with muscle pain related to the initial muscle contraction reaction. A nondepolarizing NMJ blocker may be given first to prevent some of these contractions and the associated discomfort. Administering a small dose of nondepolarizing NMJ blocker will not reduce the risk of malignant hyperthermia or increase the duration beyond the 4 to 6 minutes that is expected. Dantrolene is a drug given to treat malignant hyperthermia.

Format: Multiple Choice Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 495, Nursing Considerations for Patients Receiving Neuromuscular Junction Blocking Agents: Intervention with Rationale 33. A surgical client will be administered sedative followed by a neuromuscular junction (NMJ) blocker. What nursing action best preserves the client’s safety? A) Apply physical restraints as prescribed. B) Administer bronchodilators as prescribed to facilitate intubation. C) Auscultate the client’s apical heart rate with a stethoscope for 2 minutes. D) Ensure that emergency equipment is readily available.

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Ans: D

Feedback: It is imperative to ensure that emergency supplies and equipment are readily available to maintain airway and provide mechanical ventilation. Cardiac monitoring will negate the need for manual auscultation of the client’s heart rate. Physical restraints are only used in exceptional circumstances, and bronchodilators are not used to ease intubation.

Format: Multiple Choice Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 491, Box 28.1 Focus on Drug Therapy Across the Lifespan: NMJ Blocking Agents: Adults 34. What information regarding postanesthesia recover should the nurse provide the client who is scheduled to receive succinylcholine? A) Nausea is to be expected. B) Muscle pain is common. C) Ambulation will be initiated as soon as possible. D) Urination may be initially difficult.

Ans: B

Feedback: If succinylcholine is used, they need to be told that they may experience muscle pain and discomfort when the procedure is over. None of the other options are generally associated with postanesthesia recovery associated with succinylcholine.

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Test Generator Questions, Chapter 29, Introduction to the Autonomic Nervous System Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 505, Sympathetic Nervous System 1. A client is having an increased sympathetic response. The impulses of this sympathetic will originate in what location of the client’s central nervous system? A) cerebrum and sacral area of the spinal cord B) hypothalamus and the medulla C) cerebellum and brainstem D) thoracic and lumbar sections of the spinal cord

Ans: D

Feedback: The SNS is also called the thoracolumbar system because the CNS cells, where the impulses for the SNS originate, are located in the thoracic and lumbar sections of the spinal cord. These impulses do not originate in the brain.

Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Easy Integrated Process: Nursing Process Objective: 2

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Page and Header: 505, Sympathetic Nervous System 2. When assessing a client what assessment findings should the nurse interpret as suggesting a sympathetic response? A) decreased sweating and respiratory rate B) evidence of inflammation and decreased heart rate C) increase in blood pressure and decreased bowel sounds D) increased bowel sounds and pupil constriction

Ans: C

Feedback: When stimulated, the sympathetic nervous system prepares the body to flee or to turn and fight. Cardiovascular activity increases, as do blood pressure, heart rate, and blood flow to the skeletal muscles. Respiratory efficiency also increases; bronchi dilate to allow more air to enter with each breath, and the respiratory rate increases. Pupils dilate to permit more light to enter the eye, to improve vision in darkened areas (which helps a person to see to fight or flee). Sweating increases to dissipate heat generated by the increased metabolic activity.

Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 505, Sympathetic Nervous System 3. An anatomy and physiology instructor scratches chalk across the blackboard causing a screeching sound. Several students get a feeling like their “hair is standing on end.” This response is part of the sympathetic stress reaction and is called what? A) diaphoresis B) epistaxis C) piloerection

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D) proprioception

Ans: C

Feedback: The “goose flesh” or “hair standing on end” reaction that occurs as part of the stress response is called piloerection. Diaphoresis refers to sweating. Epistaxis is nosebleed. Proprioception is the awareness of the relative positions of body parts.

Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 505, Sympathetic Nervous System; 508, Table 29.2 4. The nurse administers a drug that stimulates the parasympathetic nervous system. What assessment finding would most clearly suggest that the drug is working? A) The client’s fingers and toes become cool. B) The client’s bowel sounds are increased on auscultation. C) The client’s heart rate goes from 64 beats/min to 78. D) The client’s pupils are visibly dilated.

Ans: B

Feedback: When the parasympathetic nervous system is stimulated, the result is increased GI motility, decreased GI secretions, decreased heart rate, and pupillary constriction.

Format: Multiple Choice Chapter: 29

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 509, Parasympathetic Nervous System 5. When the nurse administers a drug that stimulates the nicotinic receptors, what manifestation would indicate medication effects? A) increased gastrointestinal (GI) motility B) decrease in heart rate C) muscle contraction D) pupil constriction

Ans: C

Feedback: Nicotinic receptors are located in the central nervous system (CNS), the adrenal medulla, the autonomic ganglia, and the neuromuscular junction. Stimulation of nicotinic receptors causes muscle contractions, autonomic responses, and release of norepinephrine from the adrenal medulla. Increased GI motility, decreased heart rate, and pupil constriction are the result of stimulation of the muscarinic receptors.

Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 505, Sympathetic Nervous System 6. A client has just learned of a highly negative prognosis, which is entirely unexpected. What body responses should the nurse anticipate? A) increased blood pressure (BP), increased heart rate, and pupil dilation

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B) decrease sweating, decreased BP, and increased heart rate C) pupil constriction, increased respiratory rate, and decreased heart rate D) increased sweating, decreased respiratory rate, and increased BP

Ans: A

Feedback: When stimulated by a stressful or fearful situation, the sympathetic nervous system (SNS) prepares the body to flee or to turn and fight. Cardiovascular activity increases as do blood pressure, heart rate, and blood flow to skeletal muscles. Respiratory rate increases, pupils dilate, and sweating increases. Decrease in sweating, BP, heart rate, respiratory rate, and pupil constriction indicate stimulation of the parasympathetic nervous system, which would not be stimulated by fear.

Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 505, Sympathetic Nervous System; 508, Table 29.2 7. A client’s sympathetic nervous system (SNS) is stimulated by going through the hospital admission process. How will this phenomenon affect the client’s gastrointestinal function? A) The client’s blood glucose level will decrease. B) The client will be unable to have a bowel movement. C) The client will experience nausea. D) The client may vomit.

Ans: B

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Feedback: When blood is diverted away from the GI tract, bowel sounds decrease and digestion slows dramatically, sphincters are constricted, and bowel evacuation cannot occur. Nausea and vomiting do not typically occur. Blood glucose levels would tend to increase due to glucagon release and glycogen breakdown.

Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 505, Sympathetic Nervous System 8. A client is being admitted to the floor following a motor vehicle accident. The nurse is aware that physiological and psychological stress will have caused the release of aldosterone. What effect of this should the nurse anticipate? A) decreased blood pressure B) decreased serum potassium C) decreased heart rate D) decreased serum sodium levels

Ans: B

Feedback: Aldosterone, also released with adrenal stimulation, retains sodium and water and causes the excretion of potassium in the urine. As water is retained, sodium is also retained, therefore increasing serum levels. Blood pressure and heart rate are likely to increase.

Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Reduction of Risk Potential

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Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 509, Parasympathetic Nervous System 9. A client has been found to be deficient in acetylcholine, and the care team has so far ruled out any neurologic cause. What assessment should be performed? A) Assess the client’s level of mobility. B) Assess the client’s coping skills. C) Assess the client’s diet and nutritional status. D) Assess the client’s body mass index (BMI).

Ans: C

Feedback: Acetylcholine (ACh) is an ester of acetic acid and an organic alcohol called choline. Cholinergic nerves use choline, obtained in the diet, to produce ACh. A dietary deficiency could be a potential cause and would be a more likely factor than BMI, poor coping, or reduced mobility.

Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 4 Page and Header: 509, Parasympathetic Nervous System 10. A client has a neurologic disorder characterized by a deficiency of acetylcholine. In what location is acetylcholine normally synthesized? A) in the synaptic cleft between nerves and effector cells B) in the adrenal medulla C) within cholinergic nerves themselves

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D) within the gray matter of the spinal cord

Ans: C

Feedback: Cholinergic nerves use choline, obtained in the diet, to produce ACh. It is not produced in the synaptic cleft, in the adrenal medulla, or in the spinal cord.

Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 509, Parasympathetic Nervous System 11. Which client’s nicotinic receptors are likely being stimulated the most? A) a client who is anxious while waiting in the preoperative area B) a client who is taking medications for the treatment of Parkinson’s disease C) a client taking a selective serotonin reuptake inhibitor for depression D) a client who has increased bowel motility causing diarrhea

Ans: A

Feedback: Stimulation of nicotinic receptors causes skeletal muscle contractions, autonomic responses such as signs and symptoms of a stress reaction, and release of norepinephrine and epinephrine from the adrenal medulla. These receptors do not respond to levels of dopamine or serotonin. Increased bowel motility is more closely associated with stimulation of muscarinic receptors.

Format: Multiple Selection Chapter: 29

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Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 505, Sympathetic Nervous System 12. A client is experiencing a fight-or-flight response upon entering the confined environment of a magnetic resonance imaging machine. What component(s) of this response will result from actions of the hypothalamus? Select all that apply. A) increased levels of adrenocorticotropic hormone (ACTH) B) increased levels of growth hormone (somatotropin) C) reduced levels of antidiuretic hormone (ADH) D) increased levels of thyroid-stimulating hormone E) inhibition of GABA

Ans: A, D

Feedback: The hypothalamus causes the secretion of ACTH by the pituitary, leading to a release of the adrenal hormones including cortisol, which suppresses the immune and inflammatory reactions to preserve energy that otherwise might be used by these activities. The hypothalamus also causes the release of thyroid-stimulating hormone but not growth hormone. It does not inhibit GABA and ADH levels.

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13. What assessment finding of a client should the nurse attribute to the stimulation of muscarinic receptors? A) The client is drooling. B) The client appears agitated. C) The client reports pruritus (itching). D) The client’s respiratory rate is 20 breaths/min.

Ans: A

Feedback: Stimulation of muscarinic receptors causes increased saliva production. It is not associated with agitation or pruritus. A respiratory rate of 20 breaths/min is expected and is not suggestive of increased stimulation of any particular cholinergic receptor.

Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 505, Sympathetic Nervous System 14. What helps to prevent overstimulation of effector sites on nerve membranes? A) alpha1-receptors B) alpha2-receptors C) beta1-receptors D) beta2-receptors

Ans: B

Feedback: Alpha2-receptors are located on nerve membranes and act as modulators of norepinephrine release. When norepinephrine is released from a nerve ending, it crosses

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the synaptic cleft to react with its specific receptor site. Some of it also flows back to react with the alpha-receptor on the nerve membrane. This causes a reflex decrease in norepinephrine release. In this way, the alpha2-receptors help to prevent overstimulation of effector sites.

Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 4 Page and Header: 509, Parasympathetic Nervous System; 504, Table 29.1 15. The nurse is describing the differing functions of the sympathetic nervous system (SNS) and parasympathetic nervous system to a client. The nurse has explained how the SNS is associated with a “fight-or-flight” reaction. How should the nurse describe the characteristics of the parasympathetic nervous system? A) “recover and repair” B) “respond and return” C) “rest and digest” D) “reflect and recharge”

Ans: C

Feedback: Although the SNS is associated with the stress reaction and expenditure of energy, the parasympathetic nervous system is associated with activities that help the body to store or conserve energy, a “rest-and-digest” response.

Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation

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Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 503, Introduction 16. A nurse is reviewing the structure and function of the neurologic system in preparation for a work placement on a neurologic unit? What statement most accurately describes an aspect of the autonomic nervous system? A) The autonomic nervous spans the central and peripheral nervous systems. B) Cholinergic receptors are exclusively located in the sympathetic nervous system. C) Nicotinic receptors are primarily associated with the parasympathetic nervous system. D) Alpha- and beta-receptors are the two basic types of muscarinic receptors.

Ans: A Feedback: The ANS integrates parts of the central nervous system (CNS) and peripheral nervous system to automatically react to changes in the internal and external environments. Stimulation of nicotinic receptors causes skeletal muscle contractions, autonomic responses such as signs and symptoms of a stress reaction, and release of norepinephrine and epinephrine from the adrenal medulla. These responses are primarily associated with the sympathetic nervous system. Alpha- and beta-receptors are not types of muscarinic receptors; they are classified as adrenergic receptors. Cholinergic receptors exist throughout various locations in the ANS, not just the parasympathetic nervous system.

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17. The nurse administers a medication that stimulates the parasympathetic nervous system (PNS). What manifestation(s) would indicate the medication is having the desired effect? Select all that apply. A) hyperactive bowel sounds B) increased saliva production C) elevated heart rate D) urinary incontinence E) constricted pupils

Ans: A, B, E

Feedback: PNS stimulation results in increased motility and secretions in the gastrointestinal (GI) tract to promote digestion and absorption of nutrients: decreased heart rate and contractility to conserve energy and provide rest for the heart; constriction of the bronchi, with increased secretions; relaxation of the GI and urinary bladder sphincters, allowing evacuation of waste products; and pupillary constriction, which decreases the light entering the eye and decreases stimulation of the retina. While urinary sphincters relax, they do not lose control, so incontinence would not be an expected manifestation.

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C) increased bladder contraction D) signs and symptoms of a stress reaction E) release of epinephrine from the adrenal medulla

Ans: A, D, E

Feedback: Stimulation of nicotinic receptors causes muscle contractions, autonomic responses such as signs and symptoms of a stress reaction, and release of norepinephrine and epinephrine from the adrenal medulla. Stimulation of muscarinic receptors causes pupil constriction, increased gastrointestinal (GI) motility and secretions (including saliva), increased urinary bladder contraction, and a slowing of the heart rate. Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 505, Sympathetic Nervous System 19. A client’s sympathetic nervous system has been stimulated, resulting in the release of norepinephrine. Where was this client’s norepinephrine synthesized? A) in the dendrite terminal B) in the presynaptic junction C) in the postsynaptic junction D) in the axon terminal

Ans: D

Feedback: Norepinephrine is made by the nerve cells using tyrosine, obtained in the diet. Dihydroxyphenylalanine (dopa) is produced by a nerve, using tyrosine from the diet and other chemicals. With the help of the enzyme dopa decarboxylase, the dopa is converted to dopamine, which in turn is converted to norepinephrine in the axon

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terminals of adrenergic cells. The norepinephrine then is stored in granules or storage vesicles within the cell.

Format: Multiple Selection Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 509, Parasympathetic Nervous System 20. The client is undergoing chronic stress and is experiencing negative health effects. What type of drug(s) could this client receive to reduce the autonomic nervous response? Select all that apply. A) a drug that reduces sympathetic response B) a drug that increases sympathetic response C) a drug that reduces parasympathetic response D) a drug that increases parasympathetic response E) a drug that reduces central nervous system (CNS) response

Ans: A, D, E

Feedback: Decreasing sympathetic response would reduce the stress response, whereas increasing parasympathetic response would have the same effect. Although not optional, a medication that slowed down the entire nervous system would also work. In many areas, the parasympathetic nervous system works in opposition to the sympathetic nervous system (SNS). This allows the autonomic system to maintain a fine control over internal homeostasis. For example, the SNS increases heart rate, whereas the parasympathetic nervous system decreases it. Thus, the autonomic nervous system can influence heart rate by increasing or decreasing sympathetic activity or by increasing or decreasing parasympathetic activity.

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Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 505, Sympathetic Nervous System 21. A client is prescribed salmeterol, a beta2-receptor agonist. What adverse effect should the nurse anticipate based on the medication’s mechanism of action? A) hypoglycemia or unstable blood glucose levels B) nausea and vomiting C) headache and dizziness D) disorientation or decreased level of consciousness

Ans: C

Feedback: In blood vessels, beta2 stimulation leads to vasodilation, which can cause headaches and dizziness (due to reduced blood pressure). Stimulation of beta2-receptors does not lead to hypoglycemia, because it causes increased release of glucagon from the alpha cells of the pancreas; this would be more likely to cause hyperglycemia. GI and neurologic effects are not anticipated.

Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 505, Sympathetic Nervous System

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22. The nurse administers a drug that stimulates beta2-receptors. What type of health condition would this drug treat? A) heart disease B) high lipid levels C) diabetes D) respiratory disease

Ans: D Feedback: Beta2-receptors are found in the smooth muscle in blood vessels, in the bronchi, in the periphery, and in uterine muscle. Beta2-receptors also cause dilation in the bronchi. Beta1-receptor stimulation would improve some heart disease and are responsible for increased lipolysis. Because beta2-receptors increase release of glucagon and the breakdown of glycogen, increasing serum glucose levels, stimulation of these receptors would exacerbate diabetes.

Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 509, Parasympathetic Nervous System 23. The nurse is reading a client’s health record, where there is mention of a history of hyperfunction of the client’s craniosacral system. What assessment finding would be consistent with this? A) frequent diarrhea B) blood pressure 156/98 mm Hg C) heart rate 96 beats/min D) restless legs

Ans: A

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Feedback: The parasympathetic system is sometimes called the craniosacral system because the central nervous system neurons that originate parasympathetic impulses are found in the cranium (one of the most important being the vagus or 10th cranial nerve). Parasympathetic stimulation would result in diarrhea (increased GI motility), not hypertension, tachycardia, or restless legs.

Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 509, Parasympathetic Nervous System 24. The nurse administers a medication that stimulates the muscarinic receptors. What manifestations should the nurse expect to assess in this client? A) pupil dilation B) increased activity of bowel sounds C) increased heart rate D) muscle contractions

Ans: B

Feedback: Stimulation of muscarinic receptors increases gastrointestinal (GI) motility, which would cause increased activity of bowel sounds. Other effects include pupil constriction, increased urinary bladder contraction, and a slowing of the heart rate. Stimulation of nicotinic receptors causes muscle contractions.

Format: Multiple Selection Chapter: 29 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 509, Parasympathetic Nervous System 25. A client with a history of glaucoma is prescribed pilocarpine, a muscarinic receptor agonist. For what potential local and systemic effect(s) should the nurse assess? Select all that apply. A) pupil constriction B) pupil dilation C) increased secretions D) increased bladder contraction E) increased heart rate

Ans: A, C, D

Feedback: Stimulation of muscarinic receptors causes pupil constriction, increased gastrointestinal (GI) motility and secretions (including saliva), increased urinary bladder contraction, and a slowing of the heart rate. Pupils are constricted, not dilated, and heart rate slows, it does not increase.

Format: Multiple Selection Chapter: 29 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 509, Parasympathetic Nervous System 26. The nurse administers a nicotinic receptor. What physiologic effect(s) should the nurse expect? Select all that apply. A) muscle contractions

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B) release of norepinephrine from the adrenal medulla C) signs and symptoms of a stress reaction D) urinary incontinence E) hyperactive bowel sounds Ans: A, B, C

Feedback: Stimulation of nicotinic receptors causes muscle contractions, autonomic responses such as signs and symptoms of a stress reaction, and release of norepinephrine and epinephrine from the adrenal medulla. Urinary incontinence would not be associated with stimulation of the nicotinic receptors, and increased bowel activity would result from muscarinic receptors.

Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 505, Sympathetic Nervous System 27. A client is having a stress response that is causing the release of norepinephrine. This norepinephrine will be made from what dietary precursor? A) tyrosine B) thiamine C) tryptophan D) trichinosis

Ans: A

Feedback: Norepinephrine is made by adrenergic nerves using tyrosine from the diet. Thiamine and tryptophan are unrelated. Trichinosis is a sexually transmitted infection.

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Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 505, Sympathetic Nervous System 28. The nurse administers a drug that causes vasoconstriction, contracted piloerection muscles, pupil dilation, and urinary retention. What receptor is this drug most likely stimulating? A) alpha1-receptors B) alpha2-receptors C) beta1-receptors D) beta2-receptors

Ans: A

Feedback: Stimulation of alpha1-receptors results in vasoconstriction of blood vessels, increased peripheral resistance with increased blood pressure, contracted piloerection muscles, pupil dilation, thickened salivary secretions, and closure of the urinary bladder sphincter. None of the other receptors, when stimulated, would have this specific constellation of effects.

Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Easy Integrated Process: Nursing Process Objective: 2

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Page and Header: 505, Sympathetic Nervous System 29. The nurse accompanies the health care provider into the client’s room and remains after the client is told that they have cancer and a poor prognosis. The client’s respirations become rapid and deep, their pupils dilate, and they appear diaphoretic. What type of response is the nurse witnessing? A) sympathetic nervous system (SNS) response B) parasympathetic nervous system (PNS) response C) muscarinic receptor stimulation response D) nicotinic receptor stimulation response

Ans: A

Feedback: When stimulated, the SNS prepares the body to flee or to turn and fight. Cardiovascular activity increases, as do blood pressure, heart rate, and blood flow to the skeletal muscles. Respiratory efficiency also increases, bronchi dilate to allow more air to enter with each breath, and the respiratory rate increases. Pupils dilate to permit more light to enter the eye to improve vision in darkened areas. PNS would lower heart rate and blood pressure and would constrict pupils. The client’s response could not be wholly isolated to a muscarinic or nicotinic response.

Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 505, Sympathetic Nervous System 30. Diagnostic testing has revealed that a client has deficient levels of acetylcholinesterase. The nurse should anticipate what effect of this state? A) overstimulation of the pituitary gland by the hypothalamus B) excessive levels of norepinephrine

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C) inadequate metabolism of choline to produce ACh D) overstimulation of nicotinic and muscarinic receptors

Ans: D

Feedback: Once an effector cell has been stimulated by ACh, stimulation of the receptor site must be terminated and destruction of any ACh must occur. The destruction of ACh is carried out by the enzyme acetylcholinesterase. A lack of acetylcholinesterase would consequently lead to excessive ACh and overstimulation of receptors (nicotinic and muscarinic). Levels of norepinephrine and choline would remain unaffected, as would the function of the hypothalamus.

Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 4, 5 Page and Header: 505, Sympathetic Nervous System 31. After the effector cell has been stimulated by acetylcholine (ACh), what enzyme stops this stimulation and allows the effector membrane to repolarize? A) decarboxylase B) norepinephrine C) acetylcholinesterase D) catecholamine

Ans: C

Feedback: After the effector cell has been stimulated by ACh, stimulation of the receptor site must be terminated and destruction of any ACh must occur. The destruction of ACh is carried out by the enzyme acetylcholinesterase. This enzyme reacts

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with the ACh to form a chemically inactive compound. The breakdown of the released ACh is accomplished in 1/1,000 seconds, and the receptor is vacated, allowing the effector membrane to repolarize and be ready for the next stimulation. Dopa decarboxylase is an enzyme that converts dopa to dopamine. Norepinephrine is a catecholamine as are dopamine, serotonin, and epinephrine.

Format: Multiple Selection Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 503, Key Terms 32. The nurse is teaching a class about the autonomic nervous system for critical care nurses. What statement(s), if made by the nurse during the class, are accurate? Select all that apply. A) “Adrenergic receptors respond to norepinephrine.” B) “Alpha-receptors are adrenergic receptors.” C) “Cholinergic receptors are effectors that respond to acetylcholine.” D) “Cholinergic receptors include alpha- and beta-receptors.” E) “Nicotinic receptors respond to nicotine simulation.”

Ans: A, B, C, E

Feedback: The sympathetic nervous system contains the adrenergic receptors that respond to norepinephrine and include alpha- and beta-receptors. Alpha-receptors are adrenergic receptors that are found in smooth muscles of blood vessels, the eyes, and a variety of other organs. Cholinergic receptors are receptor sites on effectors that respond to acetylcholine. Nicotinic receptors are cholinergic receptors that respond to stimulation by nicotine; located between pre- and postganglionic nerves and also at the neuromuscular junctions. Alpha- and beta-receptors are adrenergic receptors.

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Format: Multiple Choice Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 503, Structure and Function of the Autonomic Nervous System 33. A client with neurologic symptoms has presented for diagnostic testing that will evaluate nerve impulse transmission. The nurse assisting with the procedure should be aware of what expected process of nerve impulse transmission? A) “The impulse travels from the central nervous system (CNS) to the preganglionic neuron to the ganglia to the postganglionic neuron to the neuroeffector cells.” B) “The impulse travels from the preganglionic neuron to the CNS to the ganglia to the postganglionic neuron to the neuroeffector cells.” C) “The impulse travels from the preganglionic neuron to the ganglia to the postganglionic neuron to the CNS to the neuroeffector cell.” D) “The impulse travels from the CNS to the neuroeffector cells to the preganglionic neuron to the ganglia to the postganglionic neuron.”

Ans: A

Feedback: The autonomic nervous system does not send impulses directly to the periphery. Instead, axons from CNS neurons end in ganglia, or groups of nerve bodies that are packed together, located outside of the CNS. These ganglia receive information from the preganglionic neuron that started in the CNS and relay that information along postganglionic neurons. The postganglionic neurons transmit impulses to the neuroeffector cells—muscles, glands, and organs.

Format: Multiple Selection

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Chapter: 29 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 503, Structure and Function of the Autonomic Nervous System; 504, Table 29.1 34. What characteristic is associated with the sympathetic nervous system? Select all that apply. A) Fight-or-flight. B) It originates in the thoracic and the lumbar spinal cord. C) Rest-and-digest. D) Acetylcholine (ACh) serves as the preganglionic neurotransmitter. E) Its point of origin is the cranium and sacral spinal cord.

Ans: A, B, D

Feedback: The sympathetic nervous system is characterized by the fight-or-flight general response while its point of origin is the thoracic and lumbar spine area. The preganglionic neurotransmitter of both the sympathetic and parasympathetic nervous systems is ACh. The parasympathetic system is associated with the rest-and-digest general response and originates in the cranium and sacral spinal cord.

Test Generator Questions, Chapter 30, Adrenergic Agonists Format: Multiple Choice Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process

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Objective: 2 Page and Header: 517, Alpha- and Beta-Adrenergic Agonists 1. A client is admitted to the emergency department with signs and symptoms of cardiogenic shock. Isoproterenol is administered intravenously. What assessment should the nurse prioritize when monitoring for therapeutic effects? A) blood pressure B) level of consciousness C) deep tendon reflexes D) signs and symptoms of hemorrhage

Ans: A

Feedback: Isoproterenol stimulates beta-adrenergic receptors. Blood pressure is increased, and heart rate is increased. These are the main desired outcomes, and for this reason, blood pressure assessment would be prioritized over the assessment of LOC, reflexes, and coagulation.

Format: Multiple Choice Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 517, Alpha- and Beta-Adrenergic Agonists 2. What client is exhibiting an expected assessment finding after the administration of a sympathomimetic drug? A) a mechanically ventilated client who is no longer “fighting” the ventilator B) a client who had a bleeding duodenal ulcer, which has stopped bleeding C) a client whose respiratory rate has changed from 9 to 18 breaths/min D) a client who has completed cardiac catheterization with no complications

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Ans: C

Feedback: Sympathomimetic drugs increase respirations. These drugs do not have significant effects on coagulation. An agitated client who is “fighting” the ventilator may become worse, not better, with sympathomimetic medication. The drugs would not be administered for cardiac catheterization due to the accompanying stimulation of the adrenergic receptors.

Format: Multiple Choice Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 517, Alpha- and Beta-Adrenergic Agonists 3. An 80-year-old client has been brought to the emergency department in shock. The client is receiving dopamine. The nurse should prioritize the assessment for what potentially serious adverse effect? A) blood dyscrasias B) cardiac arrhythmia C) hepatic toxicity D) renal insufficiency

Ans: B

Feedback: Dopamine therapy can result in cardiac arrhythmias, which can be life threatening. Older clients are more likely to experience the adverse effects associated with adrenergic agonists and should be started on lower doses and monitored closely for arrhythmias and blood pressure changes. Blood dyscrasias, hepatic toxicity, and renal insufficiency are not commonly associated with dopamine use. In fact, at lower doses, dopamine increases renal perfusion.

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Format: Multiple Choice Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 517, Alpha- and Beta-Adrenergic Agonists 4. A client has been treating seasonal rhinitis with an adrenergic agonist that they have been purchasing at a local pharmacy. The nurse recognizes the client might be using which medication? A) clonidine B) ephedrine C) dopamine D) norepinephrine

Ans: B

Feedback: Ephedrine has been used to treat seasonal rhinitis by stimulating the release of norepinephrine from nerve endings and directly acting on adrenergic receptor sites. Although ephedrine was formerly used for situations ranging from the treatment of shock to chronic management of asthma and allergic rhinitis, its use in many areas is declining because of the availability of less toxic drugs with more predictable onset and action. Clonidine is never used to treat allergies. Dopamine and norepinephrine are used to treat shock.

Format: Multiple Choice Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 523, Alpha-Selective Adrenergic Agonists 5. An older adult has been prescribed midodrine. What is the most important nursing action to include in the plan of care for this client? A) Ensure that the client has ready access to the call light. B) Assess positional blood pressures. C) Establish continuous pulse oximetry following the first dose. D) Auscultate the client’s apical heart rate hourly.

Ans: B

Feedback: Midodrine is an oral drug used to treat orthostatic hypotension in clients who do not respond to traditional therapy. It activates alpha-adrenergic receptors, leading to peripheral vasoconstriction and an increase in vascular tone and blood pressure. This effect can cause serious supine hypertension. Clients should be monitored in the standing, sitting, and supine positions to determine whether this will be a problem. It is also important to monitor heart rate and oxygenation in this client. However, assessing for supine hypertension would pose the greatest threat to the client and would take priority. Ensuring call light access is an important safety measure but is not directly related to the administration of midodrine.

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6. A client with primary hypertension has been prescribed clonidine. What should the nurse teach the client about potential adverse effects? A) “You might find that your night vision is weaker than normal.” B) “There’s a possibility that this drug might give you strange dreams.” C) “Your urine might be pink tinged but that doesn’t mean you’re bleeding.” D) “This drug might give you restless legs.”

Ans: B

Feedback: Central nervous system effects from clonidine therapy include feelings of anxiety, restlessness, depression, fatigue, strange dreams, and personality changes. Pupil dilation, decreased urine output, and anorexia are all adverse effects of clonidine. Changes in urine coloration and restless legs are not expected. The pupil dilation that is caused by clonidine would tend to enhance, not weaken, night vision.

Format: Multiple Choice Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 527, Beta-Selective Adrenergic Agonists 7. The perioperative nurse is caring for a client who is undergoing surgery. What drug should the nurse expect the client to be given if beta-specific adrenergic effects are desired to prevent bronchospasm during anesthesia? A) dobutamine B) ephedrine C) isoproterenol D) phenylephrine

Ans: C

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Feedback: Isoproterenol is a beta-specific adrenergic agonist used to prevent bronchospasm during anesthesia. Phenylephrine is an alpha-specific adrenergic agonist. Both dobutamine and ephedrine are alpha- and beta-adrenergic agonists.

Format: Multiple Choice Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 517, Alpha- and Beta-Adrenergic Agonists 8. The nurse is preparing discharge teaching for four clients. Which client should be advised by the nurse that over-the-counter cold and allergy preparations contain phenylephrine and should be avoided? A) a 47-year-old client prescribed an monoamine oxidase inhibitors (MAOIs) B) a 52-year-old client with type 2 diabetes C) a 17-year-old client with symptoms of an upper respiratory infection D) a 62-year-old client with gout

Ans: A

Feedback: Phenylephrine, a potent vasoconstrictor and alpha1-agonist with little or no effect on the heart or bronchi, is used in many combination cold and allergy products. Phenylephrine combined with MAOIs can cause severe hypertension, headache, and hyperpyrexia; this combination should be avoided. Use of this drug in clients with diabetes and gout are not contraindicated. An upper respiratory infection may be an indication for the drug.

Format: Multiple Choice

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Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 520, Nursing Considerations for Patients Receiving Alpha- and BetaAdrenergic Agonists: Assessment: History and Examination 9. The nurse is writing a plan of care for a client who is receiving an alpha-specific adrenergic agonist. What is the priority component of the client’s plan of care? A) reviewing the client’s complete blood count and electrolytes whenever available B) monitoring blood pressure and heart rate frequently C) assessing skin turgor for fluid deficit twice per shift D) assessing the client’s muscle strength bilaterally

Ans: B Feedback: Sympathetic stimulation will cause hypertension and increased heart rate, so it is important these be monitored. These assessments address a greater safety risk to the client than abnormal laboratory results, fluid imbalance, or musculoskeletal dysfunction.

Format: Multiple Choice Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 523, Alpha-Selective Adrenergic Agonists 10. A nurse receives an order for clonidine for a 25-year-old pregnant woman with poorly controlled hypertension. What is the nurse’s priority action? A) Weigh the client to confirm the correct dose/kg/day.

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B) Have a second nurse check the dose before administering the drug. C) Consult with the prescriber about the order. D) Make sure that the client is wearing a fetal monitor.

Ans: C

Feedback: The nurse would consult with the prescriber to ensure awareness of the pregnancy and desire to administer this drug. There are no adequate studies about use during pregnancy and lactation, so use should be reserved for situations in which the benefit to the mother outweighs any potential risk to the fetus or neonate. The nurse should question the prescriber regarding this order. It would not be necessary to implement the other options.

Format: Multiple Choice Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 517, Alpha- and Beta-Adrenergic Agonists 11. The nurse is preparing to administer a sympathomimetic drug to a client. How does this drug achieve a therapeutic effect? A) stimulating beta-receptors and blocking alpha-receptors B) stimulating alpha-receptors and blocking beta-receptors C) blocking adrenergic receptors D) stimulating alpha- and beta-receptors

Ans: D

Feedback: Drugs that are generally sympathomimetic are called alpha-agonists (stimulate alpha-receptors) and beta-agonists (stimulate beta-receptors). These agonists

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stimulate all of the adrenergic receptors; that is, they affect both alpha- and betareceptors.

Format: Multiple Choice Chapter: 30 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 527, Beta-Selective Adrenergic Agonists; 519, Box 30.3 12. A client has been unable to lose weight through dietary changes and has inquired about the use of ephedra for this purpose. What should the nurse teach the client? A) “Ephedra is known to have a lot of serious risks. Confirm with your provider, but it’s likely best avoided.” B) “The benefits of ephedra were greatly overstated and are a good example of ‘media hype’.” C) “It’s best to talk to your health care provider because ephedra is only effective and appropriate for some clients.” D) “Because of the safety risks that have been identified, ephedra is no longer available for sale in the United States.”

Ans: A

Feedback: The nurse should encourage the client to speak with their care provider about this matter but should also inform the client of the significant risks associated with ephedra. This does not mean, however, that ephedra is ineffective. It is still available as a herb in some states.

Format: Multiple Choice Chapter: 30

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 516, Introduction 13. A nurse is reviewing the therapeutic use of adrenergic agonists. When reviewing their use in clients of differing ages, what principle should guide the nurse’s actions? A) Most adrenergic agonists should be avoided in older adult clients. B) Most adrenergic agonists can be safely used during pregnancy and breastfeeding. C) Adrenergic agonists are considered to be agents of last resort in pediatric clients. D) Adrenergic agonists can be used for varied indications across the lifespan.

Ans: D

Feedback: The use of adrenergic agonists varies from ophthalmic preparations for dilating pupils to systemic preparations used to support clients experiencing shock. They are used in clients of all ages. Older adults must be monitored more closely in most cases, but their use is not contraindicated. They are generally incompatible with pregnancy and breastfeeding.

Format: Multiple Choice Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 521, Nursing Considerations for Patients Receiving Alpha- and BetaAdrenergic Agonists: Intervention with Rationale 14. A client in cardiogenic shock is receiving an infusion of dopamine when it is discovered that extravasation has occurred. What action is most appropriate?

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A) Discontinue the medication and administer a bolus of 250 mL of an isotonic solution. B) Administer 4- to 6-mg acetylcysteine IV as prescribed to preserve tissue integrity. C) Remove the IV cannula and irrigate the site with normal saline. D) Administer dilute phentolamine to the site, as prescribed.

Ans: D

Feedback: The nurse should maintain phentolamine on standby in case extravasation occurs; infiltration of the site with 10 mL of saline containing 5 to 10 mg of phentolamine is usually effective in saving the area. Acetylcysteine is an antidote for acetaminophen overdose and would have not benefit. Irrigating the site superficially would have no benefit. Administering a bolus could further exacerbate tissue damage.

Format: Fill-in-the-Blank Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 517, Alpha- and Beta-Adrenergic Agonists; 518, Table 30.1 15. A client in the cardiac intensive care unit has been prescribed a dobutamine infusion at 2.5 mcg/kg/min. Knowing that the client weighs 62 kg and the medication is provided at a concentration of 1,000 mcg/mL, at what rate should the client’s IV pump be set in mL/h? Record your answer to the nearest tenth.

Ans: 9.3 mL/h

Feedback: Multiplying the client’s weight by the prescribed dose/kg/min yields 155 mcg/min (2.5 × 62). Multiplying this by 60 yields the number of mcg/h: 9,300 mcg. Dividing this by 1,000 (because there are 1,000 mcg/mL) provides the rate in mL/h: 9.3.

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Format: Multiple Selection Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 517, Alpha- and Beta-Adrenergic Agonists 16. The client with a complex health history has been taking medication affecting both alpha- and beta-receptor sites in the past. What medication(s) would the nurse include in this category? Select all that apply. A) dobutamine B) epinephrine C) dopamine D) clonidine E) albuterol

Ans: A, B, C

Feedback: Agents that affect both alpha- and beta-receptor sites include dobutamine, dopamine, ephedrine, epinephrine, and norepinephrine. Clonidine is an alpha-specific adrenergic agonist; albuterol is a beta-specific adrenergic agonist.

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17. A 4-year-old child is admitted to the emergency department in shock after a motor vehicle accident. The client weighs 12.5 kg. What would be the minimum effective dose of epinephrine if the pediatric dose is 0.005 to 0.01 mg/kg IV? A) 62.5 mcg B) 75 mcg C) 80 mcg D) 87.5 mcg

Ans: A

Feedback: To calculate the minimum dosage, multiply the child’s weight in kilogram by the lower dosage range: 12.5 × 0.005 = 0.0625 mg. This equals 62.5 mcg.

Format: Multiple Selection Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 520, Nursing Considerations for Patients Receiving Alpha- and BetaAdrenergic Agonists: Intervention with Rationale; 521, Box 30.4 18. The nurse is preparing to administer a client’s scheduled ophthalmic adrenergic agonist. What action(s) should the nurse perform? Select all that apply. A) Perform hand hygiene prior to administration. B) Have the client look straight ahead and keep their head still. C) Administer a drop, and wait at least 60 seconds if more than one drop per eye of the medication is prescribed. D) Instill the drop gently on the perimeter of the client’s pupil. E) Instruct the client not to rub the eyeball after administration of the drops. Ans: A, E

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Feedback: Hand hygiene is necessary before the administration of any medication, including eye drops. The head should tilt their head up or else lie supine. Successive drops of one medication can be given one after another into the same eye, and they should be instilled into the lower conjunctival sac not near the pupil. The nurse or client should apply gentle pressure to the inside corner of the eye and avoid rubbing the eyeball.

Format: Multiple Choice Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 517, Alpha- and Beta-Adrenergic Agonists 19. The nurse is caring for a client who is receiving an intravenous infusion of dobutamine. What nursing diagnosis has most likely prompted this intervention? A) decreased cardiac output B) impaired gas exchange C) risk for peripheral neurovascular dysfunction D) ineffective peripheral tissue perfusion

Ans: A

Feedback: Dobutamine is used in the treatment of heart failure because it can increase myocardial contractility without much change in rate and does not increase the oxygen demand of the cardiac muscle. As such, it directly addresses a client’s decreased cardiac output. This would have an indirect effect on peripheral tissue perfusion while gas exchange and neurovascular function would remain largely unchanged.

Format: Multiple Choice

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Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 523, Alpha-Selective Adrenergic Agonists 20. The nurse administered a hospital client’s scheduled dose of clonidine PO 30 minutes ago. How should the nurse best assess for therapeutic effect? A) Assess the client’s blood pressure. B) Assess the client’s oxygen saturation level and assess for shortness of breath. C) Have the client ambulate in the hallway with supervision. D) Assess the client for chest pain.

Ans: A

Feedback: Clonidine specifically stimulates alpha2-receptors and is used to treat hypertension because its action blocks release of norepinephrine from nerve axons. Consequently, the nurse should assess for therapeutic effect by monitoring the client’s blood pressure. None of the other assessments as directly addresses the client’s underlying diagnosis of hypertension.

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B) a client who takes indacaterol on a daily basis C) a client who is receiving an isoproterenol infusion D) a client with a clonidine transdermal patch in place

Ans: C

Feedback: The use of an isoproterenol infusion would suggest that the client is critically ill and possibly in an emergency. Albuterol taken q.i.d. suggests an ongoing diagnosis of asthma (i.e., not status asthmaticus). Indacaterol is similarly used for ongoing asthma management. The fact that a client’s clonidine is administered transdermally suggests ongoing management of hypertension (as opposed to a hypertensive crisis).

Format: Multiple Choice Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 529, Nursing Considerations for Patients Receiving Beta-Selective Adrenergic Agonists: Intervention with Rationale 22. The nurse is preparing to give isoproterenol parenterally to a client. What should the nurse do to best protect the client’s safety? A) Confirm there is no immediate plan to intubate the client. B) Confirm that naloxone is available on the unit. C) Check the client’s latest blood type and cross-match results. D) Ensure that there is ready access to a beta-adrenergic blocker.

Ans: D

Feedback: The nurse must ensure that a beta-adrenergic blocker is readily available when giving parenteral isoproterenol in case severe reaction occurs. The need to

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intubate the client will not have a direct effect on the decision to use isoproterenol. Naloxone only resolves opioid overdoses, so it does not enhance safety. The client’s blood type is not relevant to this intervention.

Format: Multiple Choice Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 530, Key Points 23. What client would be most likely to benefit from the administration of a beta2specific adrenergic agonist? A) a client who is having an exacerbation of chronic bronchitis B) a client who is in atrial fibrillation C) a client whose blood pressure is 86/41 mm Hg D) a client whose eyes need to be dilated for an ophthalmic examination

Ans: A

Feedback: Most of the beta2-specific adrenergic agonists are used to manage and treat asthma, bronchospasm, and other obstructive pulmonary diseases. This is a more likely indication than hypotension, dysrhythmias, or a need for pupil dilation.

Format: Multiple Choice Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 5 Page and Header: 526, Nursing Considerations for Patients Receiving Alpha-Selective Adrenergic Agonists Assessment: History and Examination 24. The nurse is assessing a client who has been prescribed phenylephrine and learns that the client has a history of chronic renal failure. What should the nurse do? A) Monitor the client’s AST and ALT levels. B) Ensure that the prescriber is aware of this. C) Monitor the client’s heart rate q30min after administration. D) Document this in the client’s health record.

Ans: B

Feedback: Renal failure necessitates cautious use of phenylephrine, so it would be prudent for the nurse to confirm that the prescriber is aware of this. This would be a short-term priority over monitoring liver enzymes. The client’s blood pressure would be affected more than heart rate, and this does not relate to the client’s renal status. Documentation is necessary but does not substitute for direct communication.

Format: Multiple Choice Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 523, Alpha-Selective Adrenergic Agonists; 527, Key Points 25. The client has been taking clonidine and is now being changed to another antihypertensive drug. How should the nurse instruct the client regarding discontinuing the clonidine? A) “Check your blood pressure and pulse every 2 to 4 hours.” B) “Inform your family that the drug is being changed.” C) “Reduce clonidine gradually over 2 to 4 days.”

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D) “Keep an over-the-counter analgesic available to treat headaches.”

Ans: C

Feedback: Do not discontinue clonidine abruptly because sudden withdrawal can result in rebound hypertension, arrhythmias, flushing, and even hypertensive encephalopathy and death; taper drug over 2 to 4 days. It is not necessary to teach the client to check blood pressure and pulse every 2 to 4 hours, discuss plans for changing medications with the family, or prepare the client for severe headaches.

Format: Fill-in-the-Blank Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 527, Beta-Selective Adrenergic Agonists; 528, Table 30.3 26. An adult client has just been prescribed salmeterol. The nurse determines which information should be provided in the client teaching? A) Get up slowly from sitting or lying. B) Take one inhalation, twice per day. C) Monitor blood pressure daily. D) Replace the patch every 7 days.

Ans: B

Feedback: Salmeterol is given b.i.d. by inhalation for the treatment of asthma. It does not create a risk of orthostatic hypotension, and there is no transdermal form.

Format: Multiple Choice

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Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 527, Beta-Selective Adrenergic Agonists; 528, Table 30.3 27. A 4-year-old girl is prescribed an albuterol inhaler for asthma. What is the recommended safe dosage for this client? A) 1.25 to 2.5 mg q.i.d. B) 1.25 to 2.5 mg b.i.d. C) 2 mg q.i.d. D) 0.5 to 1 mg b.i.d.

Ans: B

Feedback: The recommended dosage for albuterol when given via inhaler is 1.25 to 2.5 mg b.i.d. When taken orally, the dosage is 2 mg t.i.d. or q.i.d. The other options are incorrect because they are outside the acceptable dosage range.

Format: Multiple Choice Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 525, Alpha-Selective Adrenergic Agonists Clinically Important Drug– Drug Interactions 28. The nurse is caring for a client who is taking a monoamine oxidase inhibitor (MAOI). The client reports seasonal rhinitis, and the health care provider (HCP) orders phenylephrine nasal spray. What is the nurse’s priority action?

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A) Verify patency of the nares. B) Review the client’s medication history. C) Question the order with the HCP. D) Position the client to give the drug as ordered.

Ans: C

Feedback: Phenylephrine, combined with MAOIs, can cause severe hypertension, headache, and hyperpyrexia. This combination should be avoided. As a result, the priority action is to remind the HCP that the client is taking an MAOI and obtain an order for a different drug. Until the new order is received, no other actions would be taken.

Format: Multiple Choice Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 517, Alpha- and Beta-Adrenergic Agonists; 518, Table 30.1 29. The nurse receives a prescription to begin a dopamine infusion at 5 mcg/kg/min. The client weighs 50 kg. Each milliliter of solution contains 3 mg of dopamine. How many mL/h should the nurse set the pump to deliver? A) 3 mL/h B) 5 mL/h C) 3,000 mL/h D) 83.3 mL/h

Ans: B

Feedback: To calculate this dosage, multiply the ordered mcg by the weight (5 ×50 kg) to yield mcg/min (250 mcg/min) and then multiply this 60 times to get mcg/h (250 × 60

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= 15,000 mcg/h). Convert mcg/h to mg/h (15,000/1,000 = 15 mg/h). Set up ratio (3 mg/1 mL = 15 mg/X mL) and cross-multiply (3X = 15 mg). Divide both sides by 3 to yield 5 mL/h to deliver 5 mg/kg/min.

Format: Multiple Choice Chapter: 30 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 516, Introduction; 517, Box 30.1 30. The nurse calculates the infusion rate for administering dopamine to a premature infant in the neonatal intensive care unit who is in cardiogenic shock secondary to a cardiac anomaly. What is the nurse’s next priority action? A) Insert an intravenous catheter. B) Obtain permission from parents. C) Ask another nurse to perform independent calculation. D) Show the nurse’s calculations to the health care provider (HCP).

Ans: C

Feedback: It is good practice to have a second person check the dosage calculation before administering the drug to avoid potential toxic effects. When having calculations double checked, it is best to let the other person work out separate calculations rather than just looking at the nurse’s calculation first because this will be more likely to catch an error. The nurse would have another nurse perform calculations rather than the HCP. Only after calculations are correct would the drug be administered, usually through a central line or the nurse may establish a peripheral line. Permission from parents is not required above general permission needed to care for the neonate.

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Format: Multiple Choice Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 520, Nursing Considerations for Patients Receiving Alpha- and BetaAdrenergic Agonists: Intervention with Rationale; 521, Box 30.4 31. The nurse is administering an ophthalmic adrenergic agonist. What action would reflect the need for further education about how to administer a medication ophthalmically? A) The nurse gently rests the tip of the dropper against the lower eyelid. B) The nurse grasps the lower eyelid and pulls it away to form a pocket. C) The nurse applies gentle pressure to the inside corner of the eye for 3 minutes. D) The nurse instructs the client to tilt their head back.

Ans: A

Feedback: First, wash hands thoroughly. Do not touch the dropper to the eye or to any other surfaces. Have the client tilt their head back or lie down and stare upward. Gently grasp the lower eyelid and pull the eyelid away from the eyeball. Instill the prescribed number of drops into the lower conjunctival sac and then release the lid slowly. Have the client close the eye and look downward. Apply gentle pressure to the inside corner of the eye. Do not rub the eyeball, and do not rinse the dropper. If more than one type of eye drop is being used, wait 5 minutes before administering the next one.

Format: Multiple Choice Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy

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Integrated Process: Nursing Process Objective: 3 Page and Header: 516, Introduction; 517, Box 30.1 32. The nurse is transcribing new orders for sympathomimetic medications prescribed for a geriatric client. What should the nurse expect the dosage to be? A) the average adult dosage B) slightly higher than adult dosages C) the lowest possible effective dosage D) approximately half the normal adult dosage

Ans: C

Feedback: Older clients should be started on lower doses of the drugs and should be monitored very closely for potentially serious arrhythmias or blood pressure changes. The other options are incorrect.

Format: Multiple Choice Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 520, Nursing Considerations for Patients Receiving Alpha- and BetaAdrenergic Agonists: Intervention with Rationale 33. The nurse is serving a breakfast tray to the client receiving an alpha- and betaadrenergic agonist medication. The nurse notifies dietary of the error with the client’s diet when finding what on the tray? A) aged cheese B) bacon C) coffee D) milk

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Ans: C

Feedback: Clients being treated with any adrenergic agonists who are also taking ma huang, guarana, or caffeine are at increased risk for overstimulation, including increased blood pressure, stroke, and death. The nurse should counsel clients to avoid these ingredients. There would be no reason to prevent the client from ingesting aged cheese, bacon, or milk.

Format: Multiple Choice Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 523, Alpha-Selective Adrenergic Agonists; 524, Box 30.5 34. What information should be provided to a client who has been newly prescribed the alpha-agonist brimonidine? A) Apply a pea-sized amount of gel to affected areas daily. B) It is safe to apply gel to lips. C) Corticosteroids can be uses in combination with the gel. D) Gel causes vasodilatation at the application site.

Ans: A

Feedback: When used topically, brimonidine is indicated to treat rosacea. It is applied in pea-sized amounts each day to the head, chin, nose, and each cheek. In the past, topical steroids were often used to help clients with this disorder, but the use of corticosteroids often made the condition worse. Brimonidine is an alpha-agonist and causes a local vasoconstriction at the site of application, decreasing the redness associated with vasodilation and improving the appearance of the skin.

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Test Generator Questions, Chapter 31, Adrenergic Antagonists Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 532, Introduction 1. The nurse administers an adrenergic blocking agent to a client. When assessing the client after administration, the nurse should expect evidence of what physiologic effect? A) antagonism of epinephrine binding sites B) inhibition of norepinephrine release C) delayed reuptake of serotonin D) increased levels of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA)

Ans: B

Feedback: Adrenergic blocking agents prevent norepinephrine from being released from the adrenal medulla or from the nerve terminal from activating the receptor, which blocks sympathetic nervous system effects. Epinephrine, serotonin, and GABA are not associated with this process.

Format: Multiple Selection Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process

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Objective: 3 Page and Header: 533, Box 31.1 Focus on Drug Therapy Across the Lifespan: Adrenergic Blocking Agents: Children 2. What prescriptions, if ordered for an 8-year-old client, should the nurse question? Select all that apply. A) amiodarone 400 mg orally per 24 hours B) labetalol 100 mg orally b.i.d. C) phentolamine 1 mg intramuscularly 1 to 2 hours before surgery D) prazosin 3 mg orally t.i.d. E) carvedilol 6.25 mg orally b.i.d.

Ans: A, B, E

Feedback: Amiodarone, labetalol, and carvedilol are not explicitly indicated for pediatric use and do not have established pediatric dosages. Phentolamine and prazosin have established pediatric dosages and would not need to be questioned.

Format: Multiple Choice Chapter: 31 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 542, Nursing Considerations for Patients Receiving Nonselective BetaAdrenergic Blocking Agents: Intervention with Rationale 3. A nurse is working with a client who is prescribed propranolol. While assessing the client’s health history, what statement should the nurse prioritize for follow-up? A) “I’ve read a lot about the benefits of vitamin B6, so I’m taking a supplement each morning.” B) “I’ve been going for acupuncture treatments twice a week to help with my high blood pressure.”

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C) “I started a rigorous exercise program. Should have started it years ago?” D) “Do you know how to do therapeutic touch? I’ve heard it can help with high blood pressure.”

Ans: C

Feedback: While exercise is generally a positive intervention, the client should follow professional advise concerning exercise. This constitutes a safety risk that the nurse should address. The nurse should also ensure that the client’s provider is made aware of their vitamin B6 use, but this likely poses less of a safety risk. Acupuncture and therapeutic touch have minimal risks and would not be a priority.

Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 532, Nonselective Adrenergic Blocking Agents 4. The nurse is caring for a client who is taking a nonselective adrenergic blocking agent. What assessment would be among the nurse’s priorities? A) monitoring respiratory rate B) checking blood glucose level C) measuring urine output D) assessing heart rate

Ans: D

Feedback: The most serious adverse effect would be severe bradycardia, so the nurse’s priority would be assessing the heart rate. If the client were identified as having diabetes, then monitoring blood glucose levels would become important because these

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drugs can aggravate diabetes by blocking sympathetic response including masking the usual signs and symptoms of hypoglycemia and hyperglycemia. Respiratory rate could be impacted if the client was identified as having a condition causing bronchospasm and diabetes because the combination could worsen both conditions. Measuring urine output should be part of the client’s care, but it is not the priority assessment.

Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 533, Box 31.1 Focus on Drug Therapy Across the Lifespan: Adrenergic Blocking Agents: Older adults 5. For which client diagnosed with hypertension would bisoprolol be the drug of choice? A) a 7-year-old client with hypertension secondary to renal parenchymal disease B) a 15-year-old client who is obese and has a sedentary lifestyle C) a 37-year-old client who is pregnant and who has gestational diabetes D) a 79-year-old client who has poor nutritional status

Ans: D

Feedback: Bisoprolol a beta1-selective adrenergic blocking agent is the drug of choice for older adults. It is not associated with as many adverse effects in older adult clients, and regular dosing profiles can be used. The client’s poor nutritional status would not contraindicate the use of bisoprolol. None of the other clients has specific indications that make bisoprolol the adrenergic blocker of choice.

Format: Multiple Choice Chapter: 31

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Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 5 Page and Header: 544, Beta1-Selective Adrenergic Blocking Agents 6. The nurse is caring for a 64-year-old client who has been diagnosed with diabetes and is being treated with a beta1-selective adrenergic blocking agent. What health education should the nurse prioritize with this client? A) the correct technique for taking their own radial pulse B) the need to weigh themselves once a week at the same time of the day C) the benefit of eating several small meals daily, rather than three larger meals D) identifying the signs and symptoms related to shortness of breath

Ans: D

Feedback: Pulmonary effects ranging from rhinitis to bronchospasm and dyspnea can occur; these effects are not as likely to occur with these drugs as with the nonselective beta-blockers. Heart rate monitoring and weekly weights are good health practices and should be done but not specifically needed by a diabetic client taking a beta-blocker. There is no particular need for the client to eat multiple small meals.

Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 546, Nursing Considerations for Patients Receiving Beta1-Selective Adrenergic Blocking Agents: Nursing Conclusions

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7. The nurse is caring for an older adult client who has just been prescribed metoprolol 75 mg PO b.i.d. What nursing diagnosis should the nurse prioritize in this client’s immediate care? A) acute pain B) risk for falls C) ineffective airway clearance D) deficient knowledge regarding drug therapy

Ans: B

Feedback: Dizziness and orthostatic hypotension are plausible adverse effects in an older adult who is just beginning to take a beta-blocker. This creates a significant risk for falls that is an acute safety risk, deserving of the nurse’s priority. Pain is a less common adverse effect that is less of a safety risk. Similarly, respiratory effects are less commonly experienced. The nurse should address the client’s knowledge, but falls prevention is a more immediate concern.

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Ans: C

Feedback: A decreased antihypertensive effect can occur if a beta-selective adrenergic blocking agent is used in combination with NSAIDs. If this combination is used, the client should be monitored closely and dosage adjustments made. Antibiotics, oral contraceptives, and thyroid supplements are not known to have a drug–drug interaction.

Format: Multiple Choice Chapter: 31 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 533, Box 31.1 Focus on Drug Therapy Across the Lifespan: Adrenergic Blocking Agents: Adults 9. A client with a long-standing history of hypertension has recently given birth to a healthy neonate. The client is planning to resume her prepregnancy regimen with an adrenergic blocker and is planning to breastfeed her infant. What health education should be provided to this client? A) It will be challenging to stagger the timing of drug administration and breastfeeding to ensure safety. B) It will be safest for the client to take a beta1-selective adrenergic blocker. C) It will be safest for the client to take an alpha1-selective adrenergic blocker. D) It will likely be necessary for the client to use an alternative form of infant feeding.

Ans: D

Feedback: Because of the risk of adverse reactions on the baby, nursing mothers should find another way to feed the baby if an adrenergic blocking drug is needed,

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regardless of what type of adrenergic blocker is used. Staggering the drug and feeding will not ensure safety.

Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 539, Nonselective Beta-Adrenergic Blocking Agents 10. The nurse provides client teaching for a client who has a new order for nadolol to treat hypertension. What statement by the client would indicate that the teaching has been effective? A) “I should avoid direct sunlight and wear sunscreen while I am outdoors.” B) “Since I am taking this drug, I’ll need to worry less about diet and exercise.” C) “I won’t stop taking this drug abruptly and will talk to my provider first.” D) “I may have a very dry mouth while taking this drug.” Ans: C

Feedback: A client receiving an adrenergic blocker must be aware that abruptly stopping the medication may result in a serious reaction. When changing medications or discontinuing their use, these drugs need to be tapered off gradually. This drug is not associated with photophobia or the anticholinergic effect of dry mouth. If the teaching were effective, the client would be aware that they would need to continue lifestyle modifications, including diet and exercise.

Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 537, Alpha1-Selective Adrenergic Blocking Agents 11. A client has been prescribed tamsulosin 0.5 mg PO daily. What assessment finding most clearly indicates that the medication is having the desired effect? A) The client’s activity level is increased, and the client denies chest pain on exertion. B) The client’s resting heart rate is 72 beats/min with regular rhythm. C) The client denies urinary hesitation or frequency. D) The client’s blood pressure is 119/77 mm Hg.

Ans: C

Feedback: Alpha1-selective adrenergic blocking agents block smooth muscle receptors in the prostate, prostatic capsule, prostatic urethra, and urinary bladder neck, which leads to a relaxation of the bladder and prostate and improved flow of urine in male clients. Tamsulosin is not given to prevent angina pain, reduce blood pressure, or modulate heart rate.

Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 5 Page and Header: 544, Patient Teaching for M.R. 12. The nurse is caring for a 55-year-old client who is receiving metoprolol PO. What statement should lead the nurse to believe that the client needs additional instruction? A) “If I have side effects from the medication, I will contact my provider before I stop taking it.”

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B) “I can take over-the-counter cold medication, provided I don’t exceed recommended doses.” C) “I’ll check my pulse each day and keep a record of it.” D) “I’ll take my medication with food.”

Ans: B

Feedback: OTC medications can interact to increase or decrease the effects of antiadrenergic drugs. The client should monitor their heart rate, and oral metoprolol should be taken with food. The client should liaise with the provider in the event of adverse effects, and the drug must not be abruptly discontinued.

Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 545, Table 31.5 Beta1-Selective Adrenergic Blocking Agents 13. A client is prescribed metoprolol extended-release PO. What assessment finding would suggest an exacerbation of the client’s underlying diagnosis? A) adventitious breath sounds B) bradycardia C) upward trend in blood pressure D) chest pain on exertion

Ans: A

Feedback: Extended-release PO metoprolol is prescribed for the treatment of heart failure. Exacerbation of heart failure often causes pulmonary and/or peripheral edema. Hypertension and arrhythmias are less likely indications for this medication. Chest pain

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on exertion suggests angina pectoris, which is not an indication for extended-release metoprolol.

Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 532, Nonselective Adrenergic Blocking Agents 14. Before administering a client’s prescribed nonselective adrenergic blocker, what should the nurse assess? A) pulse and blood pressure B) bowel sounds and appetite C) serum albumin level D) serum sodium and potassium levels

Ans: A

Feedback: The nurse should monitor vital signs and assess cardiovascular status including pulse, blood pressure, and cardiac output to evaluate for possible cardiac effects. Although assessment of bowel sounds, appetite, serum albumin level, or serum sodium and potassium levels may be important to the client care, they are not related to administration of a nonselective adrenergic blocking agent.

Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Teaching/Learning Objective: 2 Page and Header: 540, Table 31.4; 539, Nonselective Beta-Adrenergic Blocking Agents 15. A 75-year-old client being treated for angina was started on nadolol. The client questions this prescription, asking, “Why am I taking a blood pressure pill if I don’t have high blood pressure?” What is the nurse’s best response? A) “Some beta-blockers have been approved as antianginal agents.” B) “This medication will prevent blood pressure problems resulting from your angina.” C) “This drug will prevent you from developing an arrhythmia.” D) “This medication will reduce benign prostatic hypertrophy (BPH) as well as treat heart failure.”

Ans: A

Feedback: Decreased heart rate, contractility, and excitability, as well as a membranestabilizing effect, lead to a decrease in arrhythmias, a decreased cardiac workload, and decreased oxygen consumption. The juxtaglomerular cells are not stimulated to release renin, which further decreases the blood pressure. These effects are useful in treating hypertension and chronic angina and can help to prevent reinfarction after a myocardial infarction by decreasing cardiac workload and oxygen consumption. Nadolol is not used to prevent blood pressure problems or arrhythmias in the future. Nadolol is not used to treat BPH. Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 532, Nonselective Adrenergic Blocking Agents 16. In what client would the use of labetalol most likely be contraindicated? A) a 26-year-old client with viral myocarditis B) a 45-year-old client with asthma

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C) a 42-year-old client with primary hypertension D) a 65-year-old client with persistent migraines

Ans: B

Feedback: Nonselective adrenergic blocking agents are contraindicated in clients with asthma, which could be exacerbated by the loss of norepinephrine’s effect of bronchodilation. The drug would not be contraindicated in the other clients.

Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 540, Table 31.4; 539, Nonselective Beta-Adrenergic Blocking Agents 17. What assessment finding indicates to the nurse that treatment with timolol has been effective? A) The client denies dysuria. B) The client’s intraocular pressure is reduced. C) The client’s heart rate is reduced. D) The client remains free of dysrhythmias.

Ans: B

Feedback: Timolol and carteolol are available in an ophthalmic form of the drug for reduction of intraocular pressure in clients with open-angle glaucoma. A decrease in intraocular pressure would indicate it has been effective. Timolol is not used to treat tachycardia, arrhythmias, or BPH.

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Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 540, Table 31.4 Nonselective Beta-Adrenergic Blocking Agents 18. A 23-year-old client presents at the clinic with a migraine headache. What betaadrenergic blocking agent will best prevent future migraine headaches? A) propranolol B) nadolol C) timolol D) sotalol

Ans: A

Feedback: Propranolol is indicated for the treatment of hypertension, angina pectoris, idiopathic hypertrophic subaortic stenosis, supraventricular tachycardia, tremor; prevention of reinfarction after myocardial infarction; adjunctive therapy in pheochromocytoma; prophylaxis of migraine headache; and management of situational anxiety. The other options do not treat or prevent migraine headaches.

Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 533, Box 31.1 Focus on Drug Therapy Across the Lifespan: Adrenergic Blocking Agents: Children

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19. A 5-year-old client has been admitted to the pediatric intensive care unit prior to surgery. The nurse learns that the client will likely be administered phentolamine during surgery. What is the client’s most likely diagnosis? A) chronic migraines B) pheochromocytoma C) renal cell carcinoma D) idiopathic heart failure

Ans: B

Feedback: Phentolamine is used for the prevention of severe hypertension reactions caused by manipulation of the pheochromocytoma before and during surgery. Phentolamine would not be indicated for treatment of migraine headaches, renal cell carcinoma, or heart failure.

Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 540, Table 31.4 Nonselective Beta-Adrenergic Blocking Agents 20. The nurse is caring for a public speaker who has developed severe stage fright that is preventing them from working. What drug should the nurse suspect may be prescribed for this client? A) carteolol B) nebivolol C) nadolol D) propranolol

Ans: D

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Feedback: One of the indications for use of propranolol is prevention of stage fright, which is a sympathetic stress reaction to a particular situation. None of the other options are indicated for this use.

Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 539, Nonselective Beta-Adrenergic Blocking Agents 21. A client with hypertension has been administered the first prescribed dose of propranolol 45 minutes ago. What assessment finding should the nurse interpret as a possible indication of adverse effects? A) The client’s blood pressure is 109/72 mm Hg. B) The client had a loose bowel movement half an hour ago. C) The client is uncharacteristically short of breath on exertion. D) The client appears to be more agitated than a few hours earlier.

Ans: C

Feedback: Pulmonary effects of propranolol can range from difficulty breathing, coughing, and bronchospasm to severe pulmonary edema and bronchial obstruction. This is due to the loss of sympathetic bronchodilation. The client’s blood pressure is with acceptable ranges, which would not suggest an adverse effect. Diarrhea is an adverse effect of propranolol, but it would be unusual for the client to experience this only 15 minutes after the first dose. Drowsiness would be more likely than agitation.

Format: Multiple Selection

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Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 544, Patient Teaching for M.R. 22. The home care nurse is caring for a client who has been newly prescribed a nonselective beta-blocking agent. What should the nurse include in the teaching plan related to this drug? Select all that apply. A) Fatigue is common. B) Change position slowly. C) Avoid driving or operating hazardous machinery. D) Be aware of the risk for nosebleeds. E) Increase activity levels as much as possible.

Ans: A, B, C

Feedback: Clients should be taught to change position slowly, avoid driving or operating hazardous machinery, and to pace activities as a result of potential dizziness from orthostatic hypotension in order to avoid injury. Activity levels should be paced and care should be taken not to overdo. These drugs do not create a risk for nosebleeds.

Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 533, Box 31.1 Focus on Drug Therapy Across the Lifespan: Adrenergic Blocking Agents

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23. The nurse is discharging a 35-year-old client diagnosed with diabetes and who has been prescribed an adrenergic blocking agent. What is the priority teaching point for the nurse to discuss with this client? A) “Monitor blood glucose levels closely and report any instability.” B) “Document signs and symptoms of hyperglycemia and hypoglycemia.” C) “Reduce carbohydrate intake more than usual while taking the new drug.” D) “Increase insulin dosage to compensate for the drug’s effect in increasing blood sugar.”

Ans: A

Feedback: It is important for the client to be instructed to monitor blood sugar levels more frequently because adrenergic blocking agents mask the normal hypo- and hyperglycemic manifestations that normally alert clients such as sweating, feeling tense, increased heart rate, and rapid breathing. There is no need to change the diet or the diabetic medications. There may be no signs and symptoms to record because they are blocked by the adrenergic blocker. Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 544, Patient Teaching for M.R. 24. The home care nurse is providing teaching for a 59-year-old client who is taking a nonselective beta-blocker. The nurse teaches the client the importance of notifying the prescribing health care provider when what occurs related to this medication? A) if the client develops a dry cough B) if the client has an episode of diarrhea C) if the client develops signs of an upper respiratory infection D) if the client’s pulse is ≤ 60 beats/min on consecutive days

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Ans: D

Feedback: Though the individual parameters may vary, the client should generally report any persistently slow pulse to the provider. A dry cough may or may not be related to respiratory effects; if there are no other symptoms, there is likely no need to report this. Persistent diarrhea should be addressed but not a single episode. An upper respiratory infection is unlikely to be related to beta-blocker use.

Format: Multiple Selection Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 539, Nonselective Beta-Adrenergic Blocking Agents 25. A client has been prescribed propranolol to reduce and prevent angina. For what adverse effect(s) should the nurse assess this client? Select all that apply. A) sleep disturbance B) sexual dysfunction C) bronchospasm D) gastric pain E) tachycardia

Ans: A, B, C, D

Feedback: Adverse effects of propranolol that the nurse would assess for include allergic reaction, bradycardia, heart failure, cardiac arrhythmias, cerebrovascular accident, pulmonary edema, gastric pain, flatulence, impotence, decreased exercise tolerance, and bronchospasm. Propranolol can cause dreams that may be disturbing to the client.

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Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 533, Table 31.1 Nonselective Adrenergic Blocking Agents 26. The intensive care nurse is caring for a client who is in a hypertensive crisis. The client has just been given labetalol 20 mg IV with no appreciable drop in the client’s blood pressure. What is the nurse’s best action? A) Monitor the client’s blood pressure for 60 before taking further action. B) Initiate a labetalol infusion at 0.025 mg/kg/min, as prescribed. C) Administer amiodarone IV, as prescribed. D) Administer another dose in 10 minutes, as prescribed. Ans: D

Feedback: Labetalol is given at a dose of 20 mg IV, slowly with additional doses given at 10-minute intervals to a maximum dose of 300 mg for severe hypertension. It is not administered as an infusion. Waiting for 60 minutes for further interventions would be unsafe. Amiodarone is not used for the treatment of hypertensive crisis.

Format: Multiple Selection Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 533, Box 31.1 Focus on Drug Therapy Across the Lifespan: Adrenergic Blocking Agents: Adults

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27. The labor and delivery nurse assists with the birth of a newborn to a woman taking an adrenergic blocker for a congenital heart defect. What assessment(s) should the nurse perform in order to identify possible effects in the neonate? Select all that apply. A) Auscultate the neonate’s heart rate. B) Auscultate the neonate’s lungs. C) Assess the neonate’s reflexes and neurologic status. D) Auscultate the neonate’s bowel sounds. E) Inspect the neonate’s genitalia.

Ans: A, B, C

Feedback: Adrenergic blockers can affect labor, and babies born to mothers taking these drugs may exhibit adverse cardiovascular, respiratory, and CNS effects. Problems with the GI and GU systems have not been reported. Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 533, Table 31.4 Nonselective Beta-Adrenergic Blocking Agents 28. A client has been referred after an optometric examination that indicated a possibility of increased intraocular pressure. The nurse should anticipate a prescription for what medication? A) propranolol B) amiodarone C) timolol D) tamsulosin

Ans: C

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Feedback: Timolol is used to reduce intraocular pressure. Neither propranolol, amiodarone, nor tamsulosin are used for this purpose.

Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 538, Table 31.3 Alpha1-Selective Adrenergic Blocking Agents 29. The nurse is caring for several clients who are being treated with adrenergic antagonists. Which client is most likely to benefit from the administration of tamsulosin? A) a 76-year-old male client with urinary hesitation and nocturia B) an 81-year-old client admitted with pulmonary edema and exacerbation of heart failure C) a 66-year-old male client with a history of ischemic heart disease and worsening anginal pain D) a 58-year-old female client with narrow-angle glaucoma and recent loss of visual acuity

Ans: A

Feedback: Tamsulosin is used to treat benign prostatic hyperplasia, not heart failure, glaucoma, or angina.

Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 5 Page and Header: 545, Table 31.5 Beta1-Selective Adrenergic Blocking Agents 30. The nurse is caring for a client who has been diagnosed with essential hypertension and whose provider has just prescribed metoprolol 100 mcg PO b.i.d. What is the nurse’s best initial action? A) Assess the client’s heart rate and blood pressure before administering the drug. B) Contact the health care provider to clarify the choice of medication. C) Contact the health care provider to clarify the dose. D) Perform hand hygiene and confirm the client’s identity.

Ans: C

Feedback: A safe and effective dose of metoprolol would be 100 mg PO b.i.d. (not mcg). Consequently, the nurse should clarify the dose before taking further action. The other options while appropriate do not identify the option best related to the dosage issue.

Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 539, Nonselective Beta-Adrenergic Blocking Agents 31. The nurse is caring for a client who has been diagnosed with hypertension and is being treated with propranolol PO. The nurse administered a scheduled dose of the medication at 08:00. When should the nurse best assess for the intended change in blood pressure? A) 08:15 B) 08:30

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C) 09:15 D) 10:00

Ans: C

Feedback: Peak levels of propranolol exist between 60 and 90 minutes after administration. For this reason, assessing the client’s blood pressure 75 minutes after giving the drug would most likely identify the maximum effect.

Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 544, Beta1-Selective Adrenergic Blocking Agents 32. A 64-year-old client who has smoked since age 15 has been diagnosed with chronic obstructive pulmonary disease. What classification of adrenergic blocking antagonist would be safest for this client to treat angina? A) nonselective adrenergic blocking agents B) nonselective alpha-adrenergic blocking agents C) alpha1-selective adrenergic blocking agents D) beta1-selective adrenergic blocking agents

Ans: D

Feedback: Beta1-selective adrenergic blocking agents have an advantage over the nonselective beta-blockers in some cases. Because they do not usually block beta2receptor sites, they do not block the sympathetic bronchodilation that is so important for clients with lung diseases or allergic rhinitis. Consequently, these drugs are preferred for clients who smoke or who have asthma, any other obstructive pulmonary disease, or

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seasonal or allergic rhinitis. Nonselective adrenergic blocking agents block both alphaand beta-adrenergic receptors exacerbating respiratory conditions by the loss of norepinephrine’s effect of bronchodilation. Nonselective alpha-adrenergic blocking agents are not used to treat angina. Alpha1-selective adrenergic blocking agents are not used to treat angina.

Format: Multiple Choice Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 545, Table 31.5 Beta1-Selective Adrenergic Blocking Agents 33. When reviewing beta1-selective adrenergic blocking agents, which medication is found to be most often prescribed for clients diagnosed with hypertension? A) acebutolol B) atenolol C) betaxolol D) bisoprolol

Ans: B

Feedback: Atenolol is more widely used than the other drugs of this class for hypertension.

Test Generator Questions, Chapter 32, Cholinergic Agonists Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 552, Table 32.1 Direct-Acting Cholinergic Agonists 1. The client diagnosed with Sjögren’s syndrome has had cevimeline prescribed. How should the nurse best administer this medication? A) once per day, ideally in the morning B) once per day at bedtime C) three time daily with meals D) every 4 hours while the client is awake

Ans: C

Feedback: Cevimeline should be given three times a day with meals. Once or twice a day dosing would cause a decrease in therapeutic effects of the drug, and every 4 hours could lead to toxicity.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 551, Introduction 2. The nurse is assessing a client who has been prescribed a cholinergic agonist. The nurse should recognize that the therapeutic effects of this medication are due to what process? A) increased activity of dopamine receptor sites throughout the brain and spinal cord B) antagonism of gamma-aminobutyric acid (GABA) receptor sites throughout the body C) increased activity of acetylcholine receptor sites throughout the body

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D) blocking of cholinergic receptor sites throughout the brain and spinal cord

Ans: C

Feedback: Cholinergic agonists are drugs that increase the activity of acetylcholine receptor sites throughout the body. Dopamine, GABA, and norepinephrine are not associated with cholinergic agonist function.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 551, Direct-Acting Cholinergic Agonists (Muscarinic) 3. A 10-year-old child diagnosed with spina bifida is receiving bethanechol for treatment of neurogenic bladder. What assessment finding should suggest that the client is experiencing adverse effects? A) decreased level of consciousness B) diarrhea C) temperature of 100.6°F (38.1°C) D) pruritus Ans: B

Feedback: Loss of bowel and bladder control is an adverse effect of cholinergic agents that would cause stress in a child. Diarrhea and increased salivation are also potential adverse effects. Pruritus, fever, and decreased LOC are not among the more common adverse effects of bethanechol and would likely be attributable to other causes, possibly hypersensitivity or infection.

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Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 551, Direct-Acting Cholinergic Agonists (Muscarinic) 4. A nurse is writing a plan of care for a client who has been prescribed bethanechol. What outcome should the nurse include in the care plan? A) pupillary dilation B) increased blood pressure C) improved bladder function D) decreased secretions

Ans: C

Feedback: Bethanechol is prescribed for nonobstructive urinary retention and neurogenic bladder. The appropriate outcome for this client would be improved bladder function. This drug causes pupillary constriction and increased secretions. This drug would not increase blood pressure. However, it could cause hypotension in the older client.

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5. The nurse is working with a child whose recent history of neuromuscular symptoms has prompted diagnostic testing for myasthenia gravis. What medication should the nurse prepare to administer? A) atropine B) bethanechol C) edrophonium D) neostigmine

Ans: C

Feedback: Edrophonium is the drug of choice for diagnosing myasthenia gravis. Bethanechol is used to treat neurogenic bladder. Neostigmine is used for the treatment of myasthenia gravis and could be used for diagnosis if edrophonium could not be used. Atropine is an anticholinergic drug and would not be used to test for myasthenia gravis.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 560, Box 32.5 Myasthenic Crisis Versus Cholinergic Crisis 6. A client is brought to the emergency department after losing consciousness at home. The client’s low blood pressure and health history suggest a cholinergic reaction. What is the nurse’s best action? A) Ensure that there is ready access to atropine on the unit. B) Administer an intravenous bolus of 10% dextrose as prescribed. C) Anticipate the STAT administration of propranolol. D) Reposition the client in the Trendelenburg position.

Ans: A

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Feedback: The antidote for a cholinergic reaction is atropine. This drug will block the cholinergic sites. Propranolol blocks beta-receptors in the sympathetic system and would exacerbate the client’s hypotension. IV fluids would likely be prescribed, but a hypertonic solution would cause undesirable fluid shifts. Repositioning the client is a lower priority than administering atropine.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 560, Box 32.7 Another Treatment for Alzheimer’s Disease 7. Memantine hydrochloride has been prescribed for a 73-year-old client who has a confirmed diagnosis of Alzheimer’s disease. What would be the target dose for this client? A) 5 mg/d B) 10 mg b.i.d. C) 15 mg/d D) 20 mg b.i.d.

Ans: B

Feedback: The drug is started at 5 mg/d PO, increasing by 5 mg/d at weekly intervals. The target dose is 20 mg/d given as 10 mg b.i.d.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Reduction of Risk Potential

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Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 558, Indirect-Acting Cholinergic Agonists 8. A client diagnosed with Alzheimer’s disease has been taking donepezil. The client’s family state that they have been giving the client ibuprofen 400 mg three times daily for joint pain. What assessment should the nurse perform? A) Auscultate the client’s breath sounds and assess oxygen saturation. B) Review the client’s most recent hemoglobin level and do a fecal occult blood test. C) Assess for changes in the client’s level of consciousness. D) Assess the client’s postvoid residual using a bladder scanner.

Ans: B

Feedback: There could be an increased risk of gastrointestinal (GI) bleeding if donepezil is taken with a nonsteroidal antiinflammatory drug (NSAID) because of the combination of increased GI secretions and the GI mucosal erosion associated with the use of NSAIDs. This drug combination would not affect the client’s respiratory status, LOC, or urinary function. Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 558, Indirect-Acting Cholinergic Agonists 9. The Air Force nurse is treating a client who was exposed to a nerve gas. What drug should the nurse be prepared to administer? A) neostigmine B) pyridostigmine C) ambenonium

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D) edrophonium

Ans: B

Feedback: Pyridostigmine has been approved for use by military personnel who have been exposed to particular nerve gases. Neostigmine, ambenonium, and edrophonium are not approved for this use.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 551, Direct-Acting Cholinergic Agonists (Muscarinic) 10. The nurse administers a dose of carbachol to an ophthalmologic client. When assessing this client for drug effects, the nurse would expect to see effects arising from stimulation of what receptors? A) nicotinic B) alpha-adrenergic C) beta-adrenergic D) muscarinic

Ans: D

Feedback: The direct-acting cholinergic agonists are similar to acetylcholine (ACh) and react directly with receptor sites to cause the same reaction as if ACh had stimulated the receptor sites. These drugs usually stimulate muscarinic receptors within the parasympathetic system. Carbachol is used as an ophthalmic agent to induce miosis to relieve the increased intraocular pressure of glaucoma. They have no effect on alpha-

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and beta-receptors in the sympathetic nervous system and less impact on nicotinic receptors than muscarinic receptors.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 560, Box 32.5 Myasthenic Crisis Versus Cholinergic Crisis 11. The nurse is caring for a client who has been diagnosed with myasthenia gravis. The client develops progressive muscle weakness and respiratory difficulty. Edrophonium is ordered and injected, and the client’s symptoms worsen. How should the nurse interpret this response? A) myasthenic crisis B) cholinergic crisis C) anaphylactic reaction D) addisonian crisis

Ans: B

Feedback: The client with a cholinergic crisis presents with progressive muscle weakness and respiratory difficulty because the accumulation of acetylcholine at the cholinergic receptor site leads to reduced impulse transmission and muscle weakness. This is a crisis when the respiratory muscles are involved. Myasthenic crisis and cholinergic crisis display similar clinical pictures. The drug edrophonium can be used as a diagnostic agent to distinguish the two conditions. If the client improves immediately after the edrophonium injection, the problem is a myasthenic crisis, which is improved by administration of the cholinergic drug. If the client gets worse, the problem is probably a cholinergic crisis, so withdrawal of the client’s cholinergic drug along with

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intense medical support is indicated. The situation does not depict an anaphylactic reaction or an addisonian crisis, which involves glucocorticoid levels.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 558, Indirect-Acting Cholinergic Agonists 12. A new resident has just been admitted to the long-term care facility. When reviewing the client’s medication record, the nurse observes that the client is currently taking donepezil. What should the nurse include in the resident’s plan of care? A) Apply restraints when necessary during times of agitation. B) Assess the client’s muscles strength and active range of motion daily. C) Assess the client’s orientation each shift. D) Assess the client’s respiratory status once per shift.

Ans: C

Feedback: Donepezil is used to treat Alzheimer’s disease. Consequently, it would be necessary to monitor the client’s cognition. Respiratory and musculoskeletal status would be less affected. Restraints are only used as an absolute last resort.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 2 Page and Header: 560, Box 32.5 Myasthenic Crisis Versus Cholinergic Crisis 13. The 38-year-old client with a recent history of varied neuromuscular symptoms has just been administered edrophonium. The client immediately demonstrates significantly increased muscle strength. How should the nurse best interpret this finding? A) The client likely has myasthenia gravis. B) The client may have spina bifida. C) The client will require electromyography. D) The client has abnormal sympathetic nervous function.

Ans: A

Feedback: Edrophonium is administered to diagnose myasthenia gravis because administration of this drug will cause a marked increase in muscle strength immediately after administration if the client has this disease. This medication has a short duration of action: 10 to 20 minutes. None of the other listed conclusions are supported by this finding, which involves ACh receptors.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 558, Indirect-Acting Cholinergic Agonists 14. The nurse is caring for a client who has been diagnosed with myasthenia gravis and has administered a prescribed dose of pyridostigmine. The nurse assesses for an improvement in the client’s status, which results from what action? A) increasing the sensitivity of muscarinic and nicotinic receptors B) inhibiting the action of acetylcholinesterase C) increasing the sensitivity of muscarinic receptors

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D) stimulating the release of acetylcholine from axons

Ans: B

Feedback: Indirect-acting cholinergic agonists such as pyridostigmine work by reversibly blocking acetylcholinesterase at the synaptic cleft. This blocking allows the accumulation of ACh released from the nerve endings and leads to increased and prolonged stimulation of ACh receptor sites. These drugs do not directly stimulate receptors or increase ACh release.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 562, Nursing Considerations for Patients Receiving Indirect-Acting Cholinergic Agonists: Intervention with Rationale 15. A 78-year-old client is admitted to the emergency department with a heart rate of 34 beats/min. Family members tell the nurse that the client may have mistakenly taken several doses of donepezil. The nurse should anticipate what intervention to treat the client’s bradycardia? A) STAT administration of atropine B) intravenous administration of pseudoephedrine C) hemodialysis D) administration of activated charcoal

Ans: A

Feedback: Atropine can be used as an antidote for excessive doses of cholinergic drugs to reverse overdose or counteract severe reactions arising from use of cholinergic

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agonists. Atropine will block cholinergic effects that are causing this client’s heart rate to decline. Pseudoephedrine is not used for this purpose because it would not influence the root cause of the client’s bradycardia. Similarly, hemodialysis and activated charcoal would have no direct effect on the client’s problematic acetylcholine levels.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 551, Direct-Acting Cholinergic Agonists (Muscarinic) 16. The nurse administers bethanechol 25 mg PO to a client as prescribed. What assessment should the nurse prioritize when assessing for therapeutic effects? A) resting heart rate B) urine output and voiding pattern C) muscle strength D) lying, sitting, and standing blood pressures

Ans: B

Feedback: Bethanechol is often used for the treatment of nonobstructive postoperative and postpartum urinary retention and for neurogenic bladder atony. Consequently, assessment of the client’s voiding pattern is indicated. Changes in vital signs and muscle strength are not anticipated.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 560, Box 32.5 Myasthenic Crisis Versus Cholinergic Crisis 17. The nurse is caring for a client who has indirect-acting cholinergic agonists prescribed to treat myasthenia gravis. When administering this classification of drug, the nurse should assess the client for what sign of a potential toxic effect? A) paralytic ileus B) abdominal distension C) hypertension D) muscle weakness

Ans: D

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 560, Box 32.5 Myasthenic Crisis Versus Cholinergic Crisis 18. A client has received an excessive dose of atracurium, a neuromuscular junction blocker. Which indirect-acting anticholinesterase medication will most likely be administered as an antidote? A) pyridostigmine

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B) donepezil C) rivastigmine D) ambenonium

Ans: A

Feedback: Pyridostigmine is indicated as an antidote to neuromuscular junction blockers. Donepezil and rivastigmine are used to treat Alzheimer’s disease. Ambenonium is used to treat myasthenia gravis.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 552, Table 32.1 Direct-Acting Cholinergic Agonists 19. A surgical client develops nonobstructive postoperative urinary retention. What drug would the nurse expect to be ordered for this client? A) neostigmine B) bethanechol C) ambenonium D) pyridostigmine

Ans: B

Feedback: The agent bethanechol, which has an affinity for the cholinergic receptors in the urinary bladder, is available for use orally and subcutaneously to treat nonobstructive postoperative and postpartum urinary retention and to treat neurogenic bladder atony. The other options are not indicated for this purpose.

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Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 560, Box 32.7 Another Treatment for Alzheimer’s Disease 20. A client is prescribed memantine for Alzheimer’s disease. Which type of site is least likely to be affected by this medication? A) nicotinic receptor sites B) glucagon receptor sites C) gamma-aminobutyric acid (GABA) receptor sites D) muscarinic receptor sites

Ans: C

Feedback: The drug, memantine hydrochloride, has a low-to-moderate affinity for Nmethyl-D-aspartate (NMDA) receptors with no effects on dopamine, GABA, histamine, glycine, or adrenergic receptor sites. It is believed that persistent activation of the central nervous system NMDA receptors contributes to the symptoms of Alzheimer’s disease. By blocking these sites, it is thought that the symptoms are reduced or delayed.

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Page and Header: 562, Nursing Considerations for Patients Receiving Indirect-Acting Cholinergic Agonists: Intervention with Rationale 21. A client brought to the emergency department is diagnosed with cholinergic toxicity after taking several doses of the medication prescribed for Alzheimer’s disease. What is the drug of choice to treat this condition? A) atropine B) epinephrine C) lidocaine D) edrophonium (injectable)

Ans: A

Feedback: It is important to maintain atropine sulfate on standby as an antidote in case of overdose or severe cholinergic reaction. Epinephrine, lidocaine, and edrophonium would not be used for this purpose.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 558, Indirect-Acting Cholinergic Agonists; 559, Box 32.3 22. A soldier is suspected of having been exposed to nerve gas. Atropine is given to temporarily block cholinergic activity and to activate acetylcholine receptors in the central nervous system. What drug should the nurse give with the atropine to free up acetylcholinesterase to start breaking down acetylcholine? A) pyridostigmine B) pralidoxime C) neostigmine D) rivastigmine

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Ans: B

Feedback: If nerve gas exposure is expected, clients who may have been exposed are given intramuscular injections of atropine (to temporarily block cholinergic activity and to activate acetylcholine sites in the central nervous system) and pralidoxime (to free up the acetylcholinesterase to start breaking down acetylcholine). Pyridostigmine, neostigmine, and rivastigmine are not used in nerve gas exposure.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 552, Box 32.1 Focus on Drug Therapy Across the Lifespan: Cholinergic Agonists: Older Adults 23. A 77-year-old client is brought to the emergency department with a cholinergic overdose. The nurse knows that older adults are likely to have a greater number of adverse drug effects for what reason? A) They are more likely to take the medications inconsistently. B) All older adults have some type of chronic health problem. C) Older adults experience varied age-related renal and hepatic changes. D) Older adults often have a poor memory and are more likely to overdose.

Ans: C

Feedback: Older clients are more likely to experience the adverse effects associated with these drugs (e.g., central nervous system, cardiovascular, gastrointestinal, respiratory, and urinary) because of normal physiological changes associated with aging. Those clients with known renal or hepatic impairment would receive a lower dosage to

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avoid overdose. Older people are not more likely to take medications inconsistently or to take too much medication. Not all older adults have chronic health problems.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 5 Page and Header: 565, Summary 24. An 82-year-old client is newly diagnosed with Alzheimer’s disease and prescribed a cholinergic drug. The client’s adult child asks the nurse how the medication is going to help. What should the nurse explain in layman’s terms? A) “The drugs work by increasing acetylcholine (ACh) levels in the brain and slowing the progression of the disease.” B) “The drugs work by crossing the blood–brain barrier and cure the disease in the brain.” C) “The drugs work by increasing ACh levels in the brain and reverse the progression of the disease.” D) “The drugs work by crossing the blood–brain barrier and decreasing ACh levels in the neuromuscular junctions.”

Ans: A

Feedback: Acetylcholinesterase inhibitors that cross the blood–brain barrier are used to manage Alzheimer’s disease by increasing ACh levels in the brain and slowing the progression of the disease. Decreasing ACh levels in the brain does not slow the progression, reverse the progression, or cure the disease. Decreasing ACh levels at the neuromuscular junctions has no effect on Alzheimer’s disease.

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Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 554, Nursing Considerations for Patients Receiving Direct-Acting Cholinergic Agonists (Muscarinic): Intervention with Rationale 25. A client has been newly diagnosed with myasthenia gravis. What education should the nurse provide the client and family? A) the importance of taking anticholinergic medications as prescribed B) the signs and symptoms of a medication overdose C) strategies for encouraging activity when the client is tired D) the importance of monitoring level of consciousness

Ans: B

Feedback: The client who is being treated for myasthenia gravis and their significant other should both receive instruction in drug administration, warning signs of drug overdose, and signs and symptoms to report immediately to enhance client knowledge about drug therapy and to promote compliance. Clients with myasthenia gravis will experience muscle weakness and should not be pushed to do more than they can tolerate. Level of consciousness is not a central concern in clients with myasthenia gravis. The illness is treated with cholinergic agonists, not anticholinergic medications (cholinergic antagonists).

Format: Multiple Selection Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult

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Integrated Process: Nursing Process Objective: 5 Page and Header: 558, Indirect-Acting Cholinergic Agonists 26. The nurse is assessing a client who began taking donepezil a few weeks ago. What area(s) should the nurse assess related to the medication? Select all that apply. A) nutritional status B) blood pressure C) history of incontinence D) breath sounds E) hearing acuity

Ans: A, B

Feedback: Gastrointestinal (GI) adverse effects can include nausea, vomiting, cramps, dyspepsia, and diarrhea, so it is important for the nurse to assess nutritional status. This is made all the more important by the condition the drug is treating that often results in clients forgetting to eat healthfully. Blood pressure should be monitored because adverse effects of donepezil include hypotension, bradycardia, and heart block. Incontinence and respiratory adverse effects are not associated with donepezil, and hearing is not normally affected.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 558, Indirect-Acting Cholinergic Agonists 27. The nurse is assessing a client who has been diagnosed with myasthenia gravis. The nurse should anticipate the administration of what drugs? A) direct-acting cholinergic agonists

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B) muscarinic inhibitors C) indirect-acting cholinergic agonists D) nicotinic agonists

Ans: C

Feedback: The drugs used to treat clients with myasthenia gravis (MG) include several indirect-acting cholinergic agonists that do not cross the blood–brain barrier and do not affect acetylcholine transmission in the brain. These drugs include ambenonium, edrophonium, neostigmine, and pyridostigmine. None of the other options are associated with the treatment of MG.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 558, Indirect-Acting Cholinergic Agonists 28. The critical care nurse has received a prescription to administer pyridostigmine to a client. What statement is most likely true of this client? A) The client may have required an antidote for neuromuscular junction blockers. B) The client may be preoperative. C) The client may be experiencing a cholinergic crisis. D) The client may have an exacerbation of Alzheimer’s disease.

Ans: A

Feedback: Pyridostigmine is approved for management of myasthenia gravis, as an antidote to neuromuscular junction blockers, and to increase survival after exposure to nerve gas. It would exacerbate a cholinergic crisis and is not indicated as a preoperative

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drug. It would not be administered for Alzheimer’s disease, which is not characterized by acute exacerbations.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 558, Indirect-Acting Cholinergic Agonists 29. A client who has been diagnosed with myasthenia gravis is having trouble swallowing. What anticholinesterase inhibitor would be the drug of choice for this client? A) galantamine B) pyridostigmine C) donepezil D) bethanechol

Ans: B

Feedback: Pyridostigmine is preferred in some cases for the management of myasthenia gravis because it does not need to be taken as frequently and can be given parenterally for clients who are having difficulty swallowing. Galantamine and bethanechol cannot be given parenterally to the client having difficulty swallowing. Donepezil is not indicated for the treatment of myasthenia gravis but is used to manage Alzheimer’s dementia.

Format: Fill-in-the-Blank Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 558, Indirect-Acting Cholinergic Agonists; 556, Table 32.2 30. The nurse is treating a client who has been exposed to nerve gas and been prescribed pyridostigmine 0.25 mg/kg IV. The client weighs 225 lbs. What dose should the nurse administer to this client? Record your answer to one decimal place.

Ans: 25.6 mg

Feedback: The client weighs 102.27 kg (225/2.2). Multiply the client’s weight times the ordered dose per kilogram: 0.25 × 102.27 kg = 25.568 mg. Rounded to one decimal place, this becomes 25.6 mg.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 551, Direct-Acting Cholinergic Agonists (Muscarinic); 552, Table 32.1 31. The nurse is caring for a client who has been diagnosed with Sjögren’s syndrome and is receiving pilocarpine 5 mg PO t.i.d. What assessment finding represents the desired outcome? A) The client is oriented to person, place, and time. B) The client does not experience gastric reflux following meals. C) The client denies visual disturbances or decreased visual acuity. D) The client denies having a dry mouth.

Ans: D

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Feedback: Pilocarpine is indicated for treatment of Sjögren’s syndrome to treat dry mouth. It is not used to prevent vision loss, reflux, or cognitive decline.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 554, Nursing Considerations for Patients Receiving Direct-Acting Cholinergic Agonists (Muscarinic): Intervention with Rationale 32. The nurse is educating a client who has just been prescribed bethanechol. The nurse has taught the client to take the medication on an empty stomach. What is the rationale for the nurse’s instruction? A) to promote rapid absorption B) to prevent premature breakdown of the drug C) to reduce irritation of the stomach lining D) to decrease nausea and vomiting

Ans: D

Feedback: Administer bethanechol and all oral forms of direct-acting cholinergic agonists on an empty stomach to decrease nausea and vomiting. This directive is not motivated by the need to hasten absorption, prevent breakdown, or prevent gastric irritation.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand

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Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 552, Table 32.1 Direct-Acting Cholinergic Agonists 33. The nurse in the pediatric unit is caring for an infant who has been diagnosed with gastroesophageal reflux. What medication, if ordered, would the nurse administer to treat this condition? A) bethanechol B) carbachol C) cevimeline D) pilocarpine

Ans: A

Feedback: Only bethanechol is indicated for the treatment of esophageal reflux in infants and children. The other drugs treat intraocular pressure, dry mouth, or to allow surgeons to perform certain surgical procedures.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 554, Nursing Considerations for Patients Receiving Direct-Acting Cholinergic Agonists (Muscarinic): Nursing Conclusions 34. The nurse is caring for a client who is receiving carbachol to treat glaucoma. The client reports a reduction in driving at night because of the inability to see well in the dark. What is the best nursing diagnosis for this client? A) anxiety related to poor vision B) grief related to loss of driving privileges C) risk for injury related to visual changes

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D) pain related to altered vision

Ans: C

Feedback: This client is at risk for injury related to visual changes and requires safety teaching to make the home as safe as possible. Nothing indicates that the client is experiencing anxiety, grief, or pain.

Format: Multiple Choice Chapter: 32 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 47, Box 32.2 Smoking Cessation 35. Which statement made by a client who has been prescribed varenicline indicates an understanding of the planned smoking cessation program? A) “I’ll pick a date to stop smoking and begin the drug that day.” B) “There is no more smoking after day 35 of my treatment plan.” C) “I need to get involved in a support program as a part of my therapy.” D) “If in 12 weeks I’m still smoking, the medication will need to be changed.”

Ans: C

Feedback: The client should pick a date to stop smoking, begin the drug 1 week before that date, and quit smoking between days 8 and 35 of the treatment plan. The drug therapy should be part of a complete support and education program. If the client has not been able to stop smoking in 12 weeks, the drug should be stopped. The treatment regimen can be restarted after factors that prevented success are addressed.

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Test Generator Questions, Chapter 33, Anticholinergic Agents Format: Multiple Choice Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 567, Anticholinergics/Parasympatholytics 1. A nurse has administered a prescribed dose of an anticholinergic agent to a client. What assessment finding most clearly indicates a therapeutic response? A) resolution of anxiety B) reduction in respiratory rate from 29 to 20 breaths/min C) increased heart rate D) increased salivation

Ans: C

Feedback: Drugs that are used to block the effects of acetylcholine are called anticholinergic drugs. They cause a reduction in parasympathetic activity, resulting in increased sympathetic activity, such as increased heart rate. A reduction in parasympathetic activity would exacerbate, not resolve, anxiety. Anticholinergics reduce, not increase, secretions such as saliva. Respiratory rate would increase, not decrease.

Format: Multiple Choice Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning

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Objective: 2 Page and Header: 567, Anticholinergics/Parasympatholytics 2. A client who will be traveling on a ferry has been prescribed a scopolamine transdermal patch. What health education should the nurse provide to the client? A) “It’s normal for your pupils to get smaller with this drug, so don’t be surprised if someone points that out.” B) “You might find that your heart beats more quickly than usual, even when you’re at rest.” C) “Some people have diarrhea when they first start taking this, but it will usually resolve on its own.” D) “You might find yourself having to pass urine more often than you usually do.”

Ans: B

Feedback: Scopolamine blocks the parasympathetic nervous system, which may result in dilated pupils and increased heart rate (i.e., tachycardia). Blocking the parasympathetic system also results in decreased GI activity and urinary bladder tone causing constipation and urinary retention.

Format: Multiple Choice Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 568, Table 33.1 Anticholinergic Agents/Parasympatholytics 3. A client is going on a company-sponsored deep-sea fishing trip in 2 weeks. The client presents to the clinic requesting a scopolamine patch because the client is afraid that they will get seasick. What should the nurse teach the client about the use of this medication? A) “Shave the area where you’ll put it before applying the patch.”

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B) “The patch’s effectiveness will last about 72 hours.” C) “When replacing the patch, apply the new patch in the same area to maximize effectiveness.” D) “Make sure you don’t apply the patch where it will be exposed to direct sunlight.”

Ans: B

Feedback: The scopolamine patch is replaced every 3 days (i.e., 72 hours). The scopolamine patch should be applied to a clean, dry, intact, and hairless area of the body. The area should not be shaved because abrasion of the skin could occur and lead to increased absorption. Patches should be placed at new sites each time to avoid skin irritation. The patches may safely be exposed to sunlight.

Format: Multiple Choice Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 567, Anticholinergics/Parasympatholytics 4. The nurse is taking a health history on a new client who has been prescribed propantheline as adjunctive therapy for peptic ulcers. What assessment finding is most deserving of the nurse’s follow-up? A) The client has type 2 diabetes controlled with metformin and diet. B) The client takes multivitamins to “boost the immune system.” C) The client has chronic insomnia and takes zolpidem occasionally. D) The client takes timolol drops for the treatment of narrow-angle glaucoma.

Ans: D

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Feedback: Propantheline is contraindicated for a client with glaucoma because the drug could result in increased intraocular pressure due to pupil dilation. Diabetes mellitus and insomnia are not recognized as being adversely affected by this drug. The use of multivitamins is not contraindicated.

Format: Multiple Choice Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 570, Box 33.2 Focus on Cultural Considerations: The Mydriatic Effect 5. A nurse provides care in an outpatient eye surgery clinic. The nurse routinely administers preoperative medications for eye surgery. What client is likely to require an increased dosage of a mydriatic? A) an adult client with dark brown eyes B) a 31-year-old client who takes oral contraceptives C) a 51-year-old client who is obese and who smokes cigarettes D) a client who is diagnosed with type 2 diabetes

Ans: A

Feedback: Clients with dark eyes usually require an increased dosage and may have a prolonged time to peak effect. The need for an increased dose appears to be related to the amount of pigment in the person’s eyes because people with darker-pigmented eyes require a higher dose. Native Americans are not noted to experience this phenomenon, and none of the other clients’ variables indicate a need for an increased dose.

Format: Multiple Choice Chapter: 33

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 568, Table 33.1 Anticholinergic Agents/Parasympatholytics 6. A client has been newly diagnosed with irritable bowel syndrome (IBS). What medication is the nurse most likely to administer? A) atropine B) dicyclomine C) glycopyrrolate D) methscopolamine

Ans: B

Feedback: Dicyclomine is the most likely choice of anticholinergic drug for IBS. It relaxes the GI tract and is a frequent choice in the treatment of hyperactive bowel and IBS. Atropine is used to decrease secretions, for bradycardia, pylorospasm, ureteral colic, relaxing the bladder, pupil dilation, and as an antidote for cholinergic drugs. Glycopyrrolate is used to decrease secretions and as an antidote for neuromuscular blockers. Methscopolamine is used as adjunctive therapy for ulcers.

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7. A client has presented to the clinic for a follow-up visit. The client has been taking glycopyrrolate for adjunctive management of peptic ulcer disease for several weeks. What assessment question should the nurse prioritize? A) “How many times per week are you having diarrhea?” B) “How have you been dealing with the dry mouth that your medication causes?” C) “Are you having to take any over-the-counter medications to manage headaches?” D) “Do you ever feel like you’re short of breath when you perform exercise?”

Ans: B

Feedback: Clients taking anticholinergic drugs will have dry mucous membranes. Oral hygiene will be extremely important during glycopyrrolate therapy to avoid gum disease. Diarrhea, headaches, or dyspnea should not be a concern with this drug.

Format: Multiple Choice Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 5 Page and Header: 567, Anticholinergics/Parasympatholytics 8. A 73-year-old male diagnosed with Parkinson’s disease, emphysema, and benign prostatic hyperplasia has presented to the clinic for routine care. Following detailed assessment, the provider has prescribed an anticholinergic drug for the client. What is the priority teaching point that the nurse must give to the client in regard to their new medication? A) “If possible, try to avoid rooms that are cold, or going outside in cool weather.” B) “If you feel short of breath, use the rescue inhaler that you’ve been prescribed.” C) “Make sure to seek care promptly if you’re not able to urinate.” D) “Take the drug with food to avoid gastrointestinal (GI) upset.”

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Ans: C

Feedback: Due to the client’s diagnosis and drug therapy, calling the doctor if they cannot urinate would be the most important instruction. Men with BPH have difficulty urinating and if an anticholinergic drug is taken, this can lead to urinary retention and bladder sphincter spasm. Taking the drug with food should be encouraged to prevent GI upsets. However, the highest priority is addressing urinary retention issues. The drug is unlikely to affect their respiratory status. Hot environments, not cool environments, would pose a threat.

Format: Multiple Choice Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 567, Anticholinergics/Parasympatholytics 9. The nurse has administered a client’s prescribed dose of atropine that is intended to cause mydriasis and cycloplegia. Shortly after administration, the client’s pupils are fully dilated and the client reports blurred vision. What is the nurse’s best action? A) Perform an assessment of the client’s visual acuity. B) Ensure that the client keeps their eyes closed until further notice, if possible. C) Inform the client that this is expected and document the client’s report. D) Report this to the client’s care provider promptly.

Ans: C

Feedback: Atropine can be used to cause dilated pupils, which is mydriasis resulting in cycloplegia, which is the inability of the lens of the eye to accommodate leading to blurred vision. This is expected, and there is no reason to contact the care provider.

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Format: Multiple Choice Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 573, Box 33.4 Focus on Safe Medication Administration: Anticholinergic Toxicity 10. Two days ago, a client started a multiherbal “cleanse” that was described on a website. The client has now presented for care with diverse symptoms that are causing the client distress. Review of the outline of this cleanse reveal that the client may have taken between 4 and 5 mg of atropine. What assessment finding should the nurse attribute to an overdose of atropine? A) pallor and decreased level of consciousness B) urinary urgency and occasional urinary incontinence C) oxygen saturation of 91% on room air and respiratory rate 22 breaths/min D) heart rate 108 beats/min and warm, dry skin

Ans: D

Feedback: Toxicity of atropine is dose related. In a range of 4 to 5 mg, tachycardia and warm, dry skin would be expected because of extreme anticholinergic effects. Pallor would not be expected, and agitation would be more likely than decreased LOC. Urinary retention would be likely. This client’s respiratory status is not markedly affected.

Format: Multiple Selection Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate

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Integrated Process: Teaching/Learning Objective: 5 Page and Header: 571, Box 33.3 Focus on Safe Medication Administration: Applying Dermal Patch Delivery Systems 11. A client with a history of motion sickness has been prescribed a scopolamine patch. Which statement(s) by the client should lead the nurse to believe that the client knows how to use the patch effectively? Select all that apply. A) “I will place it on my chest each morning after I shower.” B) “I will use it only if I feel sick to my stomach.” C) “I will change the patch every 4 hours when I anticipate motion sickness.” D) “I will change site locations with each new patches.” E “I will remove the old patch before putting on a new one.”

Ans: D, E

Feedback: The scopolamine patch should be applied to a clean, dry, intact, and hairless area of the body. The area should not be shaved because abrasion of the skin could occur and lead to increased absorption. Patches should be placed at new sites each time to avoid skin irritation. The old patch should be removed, and the area where it had been should be cleaned. They can be kept in place for 3 days, and it is advisable that the client not take other OTC medications concurrently.

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health record that the client had a paralytic ileus in the past. What is the nurse’s best action? A) Contact the surgeon to point out the client’s health history. B) Confirm that the anesthesiologist is aware of this diagnosis. C) Anticipate the administration of a larger-than-usual dose of glycopyrrolate. D) Document this in the nurse’s notes.

Ans: B

Feedback: Anticholinergics could exacerbate a paralytic ileus or increase the client’s risk. The nurse’s best action is to communicate with the anesthesiologist, not the surgeon. A larger dose would increase the risk. Documenting this does not guarantee that other members of the team will be aware.

Format: Multiple Choice Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 573, Box 33.4 Focus on Safe Medication Administration: Anticholinergic Toxicity 13. The nurse is caring for a client who has presented to the emergency department with atropine poisoning. What is the nurse’s priority action? A) administering acetylcysteine IV, as prescribed B) administering gastric lavage, as prescribed C) reassuring the client and administering syrup of ipecac as prescribed D) administering physostigmine as prescribed

Ans: D

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Feedback: Physostigmine can be used as an antidote for atropine poisoning. A slow intravenous injection of 0.5 to 4 mg (depending on the weight of the client and the severity of the symptoms) usually reverses the delirium and coma of atropine toxicity. None of the other listed interventions would have any effect on the client’s low acetylcholine levels, which are the essence of atropine poisoning.

Format: Multiple Choice Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 568, Box 33.1 Focus on Drug Therapy Across the Lifespan: Anticholinergic Agents/Parasympatholytics: Older Adults 14. An 81-year-old client has been prescribed an anticholinergic drug. What action should the nurse perform to best protect the client’s safety? A) Protect the client from exposure to excessively hot temperatures. B) Keep the client’s bedrails fully raised at all times. C) Limit the client’s fluid intake to 1.5 L/day, unless contraindicated. D) Ensure that the client knows to avoid high-potassium foods and salt substitutes.

Ans: A

Feedback: Because older clients are more susceptible to heat intolerance owing to decreased body fluid and decreased sweating, extreme caution should be used when an anticholinergic drug is given that reduces sweating still further and can result in heat stroke. Fluids should be encouraged, not limited, and there is no need to avoid potassium. Raised side rails should be used judiciously; in some circumstances, they may enhance safety, but in others, they may pose a safety risk.

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Format: Multiple Choice Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 567, Anticholinergics/Parasympatholytics 15. A client received atropine and meperidine preoperatively. After surgery, the client reports mouth dryness. What is the nurse’s best response? A) “Your medications decreased saliva production, but it is temporary and will improve.” B) “This is likely the result of the blood and fluid you lost during surgery, coupled with the fact that the operating room is very dry.” C) “You are likely dehydrated, which is common after surgery. The IV fluids you are receiving will correct the problem.” D) “The preoperative medication often causes a temporary electrolyte imbalance making your mouth feel dry.”

Ans: A

Feedback: Clients receiving anticholinergic drugs must be monitored for dry mouth, difficulty swallowing, constipation, urinary retention, tachycardia, pupil dilation and photophobia, cycloplegia and blurring of vision, and heat intolerance caused by a decrease in sweating.

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16. The nurse is providing care for a client who has been prescribed fesoterodine. When monitoring for intended therapeutic effects, what assessment should the nurse prioritize? A) assessing the quantity and character of the client’s secretions B) assessing the client for gastric pain and assessing stool for occult blood C) assessing the client’s voiding pattern and assessing for postvoid residual D) assessing the frequency of the client’s diarrhea

Ans: C

Feedback: Fesoterodine is prescribed to treat overactive bladder and urge incontinence. For this reason, urinary assessment would take priority over GI assessment or assessment of secretions and diarrhea.

Format: Multiple Selection Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 567, Anticholinergics/Parasympatholytics 17. Which client(s) are likely to benefit from the administration of an anticholinergic medication? Select all that apply. A) an 82-year-old client in the early stages of Alzheimer’s disease B) a 76-year-old client who has been diagnosed with Parkinson’s disease C) a client who has lived with an overactive bladder for several years D) a client whose heart rate is 111 beats/min with irregular rhythm E) a client who has been admitted to the emergency department after eating wild mushrooms

Ans: B, C, E

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Feedback: Indications for anticholinergics include Parkinson’s disease, treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency bronchial asthma (bronchospasm), and mushroom poisoning. Alzheimer’s disease is treated with cholinergic agonists. Administration of anticholinergics would often exacerbate tachycardia.

Format: Multiple Choice Chapter: 33 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 567, Anticholinergics/Parasympatholytics 18. A client, age 79, is started on flavoxate for the treatment of cystitis related to urinary tract infection. When planning the client’s care, what nursing diagnosis should the nurse prioritize? A) ineffective thermoregulation related to decreased sweating B) acute pain related to vasodilation as evidenced by headaches C) risk for imbalanced fluid volume related to diuresis D) risk for falls related to CNS effects

Ans: D

Feedback: The nurse should be aware of possible blurring of vision when taking this drug, which could put the client at risk for injury if precautions are not taken. Pain is unlikely because vasodilation and headaches are not typical adverse effects. The client is expected to resume normal urinary function, but this does not create a risk for imbalanced fluid volume. Impaired thermoregulation is a possibility, but in most cases, the client’s risk for falls is more acute and is therefore a nursing priority.

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Format: Multiple Choice Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 4 Page and Header: 567, Anticholinergics/Parasympatholytics 19. The perioperative nurse is caring for a surgical client whose anesthesiologist has just administered atropine. When assessing the client, what finding should the nurse interpret as achieving the desired effect? A) The client expresses no anxiety about the administration of anesthesia. B) The client’s pupils are dilated and minimally responsive to light. C) There is less than 50 mL of urine in the client’s urinary catheter collection bag. D) There is no evidence of excessive oral or bronchial secretions.

Ans: D

Feedback: Atropine is administered preoperatively to reduce secretions, but added indications include gastrointestinal (GI) effects that reduce GI activity. Atropine has no sedating or relaxing effects and is not given preoperatively for its pupil dilation effects. It is not given to reduce urine output.

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20. The critical care nurse is providing care for a client whose heart rate has dropped to 29 beats/min. The care provider has prescribed atropine 0.5 mg IV. What is the nurse’s best action? A) Contact the provider to question the choice of medication. B) Confirm the dose with the care provider. C) Confirm the client’s identity, administer the drug, and monitor closely. D) Clarify the desired route with the client’s provider.

Ans: C

Feedback: The usual dosage for atropine is 0.4 to 0.6 mg intramuscularly, subcutaneously, or IV; use caution with older clients. The most likely route is IV in a critical care situation, so there is no need to confirm this with the provider.

Format: Multiple Choice Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 568, Box 33.1 Focus on Drug Therapy Across the Lifespan; Anticholinergic Agents/Parasympatholytics: Children 21. The pediatric nurse is preparing to administer an anticholinergic drug to a client. When assessing for adverse and therapeutic effects, what assessment should the nurse prioritize? A) skin integrity B) oral temperature C) urine output D) blood pressure

Ans: C

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Feedback: Children are often more sensitive to the adverse effects of anticholinergics, including urinary retention. The client will be prone to heat intolerance, but oral temperature is not likely to vary widely. Anticholinergics do not normally have a large effect on blood pressure, and there is no obvious threat to the pediatric client’s skin integrity.

Format: Multiple Choice Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 568, Table 33.1 Anticholinergic Agents/Parasympatholytics 22. The nurse is writing a plan of care for an older adult client taking flavoxate. What is an appropriate goal for this client’s plan of care? A) The client will have adequate pupil dilation within 15 minutes. B) The client will experience relief from bronchospasm within 5 minutes. C) The client will experience fewer symptoms of prostatitis within 24 hours. D) The client will show resolution of peptic ulcer within 6 weeks.

Ans: C

Feedback: Flavoxate is used to relieve symptoms of dysuria, urgency, nocturia, suprapubic pain, frequency, and incontinence associated with cystitis, prostatitis, urethritis, urethrocystitis, and urethrotrigonitis. As a result, the nurse would know that the drug was working when the client experienced fewer symptoms related to any one of these conditions. Because the drug is not indicated for pupil dilation, bronchospasm, or treatment of a peptic ulcer, the nurse’s outcomes would not be related to these conditions.

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Format: Multiple Choice Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 568, Table 33.1 Anticholinergic Agents/Parasympatholytics 23. The nurse is working with a client whose medication regimen includes ipratropium. What action is most appropriate when providing care for this client? A) Ensure that the lighting in the client’s room is not excessively bright. B) Monitor the client’s vital signs every hour. C) Encourage fluid intake and monitor urine output each shift. D) Assess respiratory status each shift and space activities to prevent fatigue.

Ans: D

Feedback: Ipratropium is indicated for the treatment of bronchospasm associated with COPD. Consequently, respiratory assessment and prevention of fatigue are necessary. Ipratropium does not normally cause wide variations in vital signs, and it is not associated with excessive pupil dilation and photophobia. The drug is not used to treat dysuria and is not associated with hesitancy as an adverse effect.

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Anticholinergic Agents/Parasympatholytics: Children 24. A 72-year-old client is being discharged home from the hospital on newly prescribed anticholinergic drugs. A referral to the home health nurse has been made. What priority teaching point will the home health nurse emphasize when discussing the client’s drugs? A) “Do not drive until you adjust to your medication.” B) “Take hot baths or showers to relieve side effects.” C) “Keep the house warm to avoid a chill.” D) “Limit your intake of fluids to avoid urinary side effects.”

Ans: A

Feedback: Safety precautions may be needed if blurred vision and dizziness occur. The client should be urged not to drive or perform tasks that require concentration and coordination. The home care nurse would not teach the client to take hot baths or showers and should be cautioned about inability to perspire in hot environments. Fluid intake should not be limited.

Format: Multiple Choice Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 567, Anticholinergics/Parasympatholytics 25. A client has been administered a scheduled dose of atropine to treat bradycardia. The nurse understands that the therapeutic effects of the drug are due to: A) increased reuptake of ACh in the synaptic clefts of the parasympathetic nervous system. B) agonism of the alpha- and beta-adrenergic receptors in the sympathetic nervous system. C) blocking of the muscarinic and nicotinic receptors in the peripheral nervous system.

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D) antagonism of the muscarinic effectors in the parasympathetic nervous system.

Ans: D

Feedback: Both atropine and scopolamine work by blocking only the muscarinic effectors in the parasympathetic nervous system and the few cholinergic receptors in the sympathetic nervous system (SNS), such as those that control sweating. They act by competing with acetylcholine for the muscarinic acetylcholine receptor sites. They do not block the nicotinic receptors and therefore have little or no effect at the neuromuscular junction. Muscarinic and nicotinic receptors are in the parasympathetic NS, not the peripheral NS. Anticholinergics do not work by increasing reuptake of ACh.

Format: Multiple Selection Chapter: 33 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 574, Box 33.5 Focus on Herbal and Alternative Therapies 26. The client, who takes an anticholinergic medication, tells the nurse about some of the herbal supplements that a website recommends. What herb(s) should the nurse caution the client to avoid? Select all that apply. A) belladonna B) thyme C) mandrake D) parsley E) moonflower

Ans: A, C, E

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Feedback: The risk of anticholinergic effects can be exacerbated if anticholinergic agents are combined with belladonna, mandrake, moonflower, and several types of muscarinic mushroom species. Advise clients who use herbal therapies to avoid these combinations. Nothing indicates that thyme or parsley is contraindicated with anticholinergic medications.

Format: Multiple Choice Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 567, Anticholinergics/Parasympatholytics 27. A 71-year-old client has sought care due to recent bradycardia, and the nurse’s initial assessment reveals a heart rate of 42 beats/min. Upon reviewing the client’s health history, the nurse also learns that the client has comorbidities of myasthenia gravis and type 1 diabetes. What aspect of this client’s health status would contraindicate the safe use of an anticholinergic? A) the client’s age B) myasthenia gravis C) diabetes D) heart rate ≥ 40 beats/min

Ans: B

Feedback: Though exceptions exist in some circumstances, most clients with myasthenia gravis would experience a severe exacerbation of their symptoms with the administration of an anticholinergic medication. The client’s age, current heart rate, and diabetes do not prevent contraindications.

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Ans: D

Feedback: The nurse would assess breath sounds because ipratropium is indicated for treatment of bronchospasm, so it is important to get a baseline assessment to determine whether the drug improves the client’s condition after administration. Vital signs and recent injuries are all valid assessments but are likely to have been assessed during admission history taking and are not related to the purpose of administering the drug.

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29. The nurse is caring for a client who has just been started on scopolamine 0.32 mg IM. What assessment question should the nurse prioritize when following up the administration of the drug? A) “How would you rate your nausea right now?” B) “Have you been able to swallow now?” C) “Are you feeling short of breath anymore?” D) “How would you rate your stomach pain right now?”

Ans: A

Feedback: Scopolamine is exclusively used for the treatment of nausea, vomiting, and motion sickness. For this reason, questions about the client’s swallowing, respiratory status, and gastric pain would not be necessary or appropriate.

Format: Multiple Selection Chapter: 33 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 577, Summary 30. The nurse is caring for a client who is experiencing parasympathetic nervous system blockade. What assessment finding(s) support this diagnosis? Select all that apply. A) diaphoresis B) decrease in urinary bladder tone C) increase in heart rate D) pupil constriction E) decrease in gastrointestinal (GI) activity

Ans: B, C, E

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Feedback: Parasympathetic nervous system blockade causes an increase in heart rate, decrease in GI activity, decrease in urinary bladder tone and function, and pupil dilation and cycloplegia. Dry skin, not diaphoresis, would be expected.

Format: Multiple Choice Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 567, Anticholinergics/Parasympatholytics 31. While being intubated, a client with a head injury experienced bradycardia. Atropine was consequently administered. What assessment should be postponed until all atropine is excreted and no longer exerting an effect? A) pupil response B) electroencephalogram C) brainstem reflexes D) computed tomography of the brain

Ans: A

Feedback: One test for neurological function is to shine a light in the client’s eyes to test pupil reaction to light. Because this client has received atropine, pupils will be dilated and will not react normally to light. This could be mistaken as an indication of brain death if the nurse did not know atropine had been administered. This test will be postponed until the pupils are no longer dilated by the medication. The other tests would not have to be postponed because of atropine.

Format: Multiple Choice Chapter: 33

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 568, Table 33.1 Anticholinergic Agents/Parasympatholytics 32. The nurse is caring for a client who is unconscious and requires an anticholinergic drug to treat bradycardia. What drug can the nurse administer IV for this purpose? A) ipratropium B) dicyclomine C) methscopolamine D) atropine

Ans: D

Feedback: Atropine can be given intramuscularly (IM), subcutaneously, or IV for the treatment of bradycardia. Ipratropium is administered by inhalation to treat bronchospasm. Dicyclomine is used to treat irritable or hyperactive bowel and can be given orally or IM. Methscopolamine is administered orally to treat peptic ulcers. Format: Multiple Choice Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 568, Table 33.1 Anticholinergic Agents/Parasympatholytics 33. A client has sought care for motion sickness and has been prescribed a scopolamine patch. What dosage will give the client the best balance between risks and benefits? A) 0.32 to 0.65 mg B) 1.5 mg C) 3 mg D) 3.5 mg

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Ans: B

Feedback: The scopolamine transdermal patch is 1.5 mg. If administered subcutaneously (SC) or intramuscularly (IM), the dosage would be 0.32 to 0.65 mg. Pediatric dosage is 0.006 mg/kg subcutaneous, IM, or IV.

Format: Fill-in-the-Blank Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 568, Table 33.1 Anticholinergic Agents/Parasympatholytics 34. The nurse receives a prescription to administer glycopyrrolate 0.002 mg/kg to the pediatric client preoperatively. The client weighs 14 lb. How many micrograms should the nurse administer to this client? Round your answer to the nearest microgram.

Ans: 13 mcg

Feedback: Begin by calculating the child’s weight in kilogram 14 lb/2.2 kg = 6.36 kg. Multiply child’s weight in kilogram by dosage in kg 6.36 × 0.002 = 0.01272 rounded to 0.013 mg. Multiplying by 1,000 gives the dose in micrograms: 13 mcg.

Format: Multiple Choice Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 3 Page and Header: 568, Table 33.1 Anticholinergic Agents/Parasympatholytics 35. A parent calls the pediatric clinic and tells the nurse that the family is planning a cross-country trip to visit some attractions the children will enjoy. Their 2-year-old child gets motion sickness soon after starting the car, and the parent would like some scopolamine patches to use. What is the nurse’s best response? A) “One patch lasts for 3 days. How long will you be driving?” B) “Scopolamine isn’t recommended for children, either orally or by patch.” C) “It might be better to use the oral form of the drug only on days it is needed.” D) “Scopolamine loses effectiveness if it is used for several days.”

Ans: B

Feedback: Scopolamine does not come in a pediatric oral or patch formulation. Scopolamine can only be given to a child through a subcutaneous injection or IV. Because children cannot use the patch, asking how many days they will be traveling or suggesting oral prescription when that form is not available is incorrect. Scopolamine does not lose effectiveness.

Format: Multiple Choice Chapter: 33 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 573, Box 33.4 Focus on Safe Medication Administration: Anticholinergic Toxicity 36. A client has been diagnosed with anticholinergic toxicity and is presenting with a prolonged QRS interval. What intervention should the nurse be prepared to implement for this specific client? A) repeating the EKG

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B) administering sodium bicarbonate C) administering a benzodiazepine D) placing the client on a cooling mattress

Ans: B

Feedback: Administration of sodium bicarbonate can be beneficial for treating anticholinergic poisoning in the presence of prolonged QRS intervals or arrhythmias, so an EKG is helpful with guiding management. Benzodiazepines may be administered to treat severe agitation and/or seizure activity. Cooling may be needed if the client is hyperthermic.

Test Generator Questions, Chapter 34, Introduction to the Endocrine System Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 581, Introduction 1. The nurse is reviewing the results of a client’s diagnostic testing. What substance should the nurse identify as a hormone? A) acetylcholine B) norepinephrine C) nucleic acid D) serotonin

Ans: B

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Feedback: A hormone is secreted directly into the bloodstream and travels from the site of production to react with specific receptor sites to cause an action. Norepinephrine, which is a neurotransmitter, is a hormone when it is produced in the adrenal medulla, secreted into circulation, and travels to norepinephrine receptor sites to cause an effect. Acetylcholine and serotonin are neurotransmitters but are not hormones. Nucleic acid is used to build deoxyribonucleic acid and ribonucleic acid and is not categorized as being a hormone.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 3 Page and Header: 583, The Hypothalamus 2. What organ should the nurse recognize as the coordinating center for the nervous and endocrine responses to internal and external stimuli? A) hypothalamus B) pituitary gland C) cerebral cortex D) medulla oblongata

Ans: A

Feedback: The hypothalamus is the coordinating center for the nervous and endocrine responses to internal and external stimuli. The pituitary has an important role in maintaining homeostasis, but it does not connect the nervous and endocrine systems. Similarly, the cerebral cortex and the medulla oblongata have vital neurologic functions but do not perform roles in the central coordination of endocrine function.

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Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 582, Hormones 3. The nurse is reviewing the structure and function of the endocrine system before providing care on a medical unit. What criterion can the nurse use to describe all hormones? A) They are produced in large amounts in response to threats to homeostasis. B) They circulate indefinitely until they are eventually used by receptor cells. C) They are secreted directly from a gland to the tissue that they affect. D) They are transported through the blood to specific receptor sites.

Ans: D

Feedback: Hormones are chemicals that are produced in the body and meet specific criteria. All hormones are produced in very small amounts and are secreted directly into the bloodstream. They travel in the blood to specific receptor sites throughout the body and are immediately broken down.

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4. The nurse is caring for a client who has been diagnosed with abnormally low serum calcium levels. How will the client’s endocrine system most likely respond? A) temporary reduction in aldosterone levels B) increased calcitonin release from the thyroid gland C) increased release of erythropoietin from the kidneys D) increased synthesis and release of parathyroid hormone

Ans: D Feedback: In response to hypocalcemia, parathyroid hormone levels are increased, resulting in increased serum calcium levels. Calcitonin is produced and secreted by the thyroid gland in direct response to serum calcium levels and would have the opposite effect. Erythropoietin is released by the juxtaglomerular cells in the kidney in response to decreased pressure or decreased oxygenation of the blood flowing into the glomerulus; it has no direct effect on calcium levels. Aldosterone indirectly affects blood pressure, not calcium levels.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 3 Page and Header: 583, The Hypothalamus 5. The nurse explains the main purpose of the hypothalamus in regulating the central nervous system (CNS), autonomic nervous system (ANS), and endocrine system is to achieve what? A) regulation of negative feedback systems. B) creation and maintenance of a diurnal rhythm. C) maintenance of homeostasis. D) maximization of overall body metabolism.

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Ans: C

Feedback: The hypothalamus maintains internal homeostasis by sensing blood chemistries and by stimulating or suppressing endocrine, autonomic, and CNS activity. The negative feedback system is one way homeostasis is maintained, but it is not the overall goal or purpose of the system. Diurnal rhythm refers to the release of hormones at various times of the day, which is not the goal of the system. Metabolic activity accompanies all of the endocrine system’s functions but is not the purpose of the system.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 582, Hormones 6. While caring for a client diagnosed with diabetes, the nurse explains that insulin is produced by the pancreas and does what when reacting with a cell? A) metabolizes glucose B) allows water and glucose to enter the cell C) alters cellular messenger ribonucleic acid (RNA) D) changes the cell permeability to glucose

Ans: D

Feedback: Insulin reacts with specific receptor sites on the cell membrane to change the cell’s permeability to glucose to allow glucose to enter the cell. It does not affect water transport or messenger RNA. Insulin does not metabolize glucose but rather helps it move into the cell where it supplies energy for cellular activity.

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Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 582, Hormones 7. What hormone enters the cell and reacts with a receptor inside the cell to change messenger ribonucleic acid and affect the cell’s function? A) estrogen B) insulin C) calcitonin D) thyroid-stimulating hormone

Ans: A

Feedback: Estrogen enters the cell and reacts with a receptor site inside of the cell to make changes and produce an action. This does not happen quickly, and it may take months to years to produce the changes. Insulin, calcitonin, and thyroid-stimulating hormone react with specific receptor sites on the cell membrane to stimulate change and action within the cell.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 586, The Intermediate Lobe

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8. The client’s body modulates pain perception as a result of the production of what in the intermediate lobe of the pituitary gland? A) antidiuretic hormone (ADH) B) endorphins C) adrenocorticotropic hormone (ACTH) D) oxytocin Ans: B

Feedback: Endorphins and enkephalins are produced by the intermediate lobe of the pituitary gland and occupy specific endorphin receptor sites in the brainstem to block the perception of pain. Oxytocin and ADH are produced by the posterior pituitary gland, and ACTH is produced by the anterior pituitary gland.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 4 Page and Header: 586, Hypothalamic–Pituitary Axis 9. The nurse explains the purpose of the negative feedback system used by the endocrine system is what? A) to change the environment of the pituitary gland B) to maximize the efficiency of the endocrine system C) to maintain hormone concentration at an ideal level D) to control the action of hormones on target cells

Ans: C

Feedback: The negative feedback system is a control system in which increasing levels of a hormone lead to decreased levels of releasing and stimulating hormones, leading to decreased hormone levels, which stimulates the release of releasing and stimulating

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hormones; it allows tight control of the endocrine system. It does not involve changing the environment of the pituitary gland or controlling the action of hormones on target cells. Homeostasis, not efficiency, is the overall goal of the system.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 585, The Anterior Pituitary 10. Melanocyte-stimulating hormone (MSH) has been released from a client’s anterior pituitary. What effect will this have? A) blocking the client’s perception of pain B) temporarily suppressing the immune system C) stimulating fat mobilization D) stimulating nerve growth and development

Ans: D

Feedback: MSH might be important for nerve growth and development in humans. MSH also plays an important role in animals that use color change as an adaptive mechanism. Lipotropins stimulate fat mobilization. Endorphins and enkephalins are hormones that block the perception of pain. MSH has no effect on the function of the immune system.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process

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Objective: 1 Page and Header: 582, Table 34.1 Endocrine Glands with Associated Hormones and Clinical Effects 11. The nurse is caring for a client who has been diagnosed with a condition resulting in inadequate production of cholecystokinin. What would the nurse expect to find when assessing this client? A) elevated serum sodium and reduced serum potassium levels B) increased bowel sounds C) increased numbers of red blood cells D) increased serum calcium levels

Ans: B

Feedback: Cholecystokinin is secreted by the intestine and decreases gastric movement resulting in diminished bowel sounds as well as stimulation of bile and pancreatic juice secretion. Decreased amounts of cholecystokinin would consequently result in increased bowel sounds. Aldosterone causes sodium retention and potassium excretion. Erythropoietin increases red blood cell production. Parathyroid hormone causes an increase in serum calcium levels.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 582, Table 34.1 Endocrine Glands with Associated Hormones and Clinical Effects 12. A client has a disruption in the regulation of metabolic rate. Diagnostic testing is most likely to reveal abnormal levels of what hormone? A) parathyroid hormone

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B) thyroid hormone C) cortisol D) insulin

Ans: B

Feedback: Thyroid hormone regulates the metabolic rate of the body and greatly influence growth and development. Parathyroid hormone influences calcium levels, and cortisol is involved in the stress response. Insulin regulates glucose levels.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 585, The Anterior Pituitary 13. The client’s anterior pituitary hormone secretion is impacted by time of day and activity level. What do the levels of these hormones follow? A) a diurnal rhythm B) a physiological rhythm C) an unpredictable pattern D) a biannual pattern

Ans: A

Feedback: The anterior pituitary hormones are released in a rhythmic manner into the bloodstream. Their secretion varies with time of day (often referred to as diurnal rhythm) or with physiological conditions, such as exercise or sleep. A biannual rhythm would be twice a year. Patterns of release are consequently predictable. There is no such thing as a physiological rhythm.

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Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 582, Hormones 14. Some hormones react with specific receptor sites on a cell membrane and stimulate what within the cell? A) meiosis B) cyclic adenosine monophosphate C) dopamine synthesis D) acetylcholine release

Ans: B

Feedback: Some hormones react with specific receptor sites on a cell membrane to stimulate the nucleotide cAMP within the cell to elicit an effect. Hormones that react with specific receptor sites do not stimulate meiosis. Dopamine and ACh levels are not influenced by the endocrine system.

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15. Estrogen enters the cell and reacts with a receptor site. What is the final result of this reaction? A) Deoxyribonucleic acid (DNA) is affected. B) Ribonucleic acid enters the cell nucleus. C) Cellular function is altered. D) Messenger RNA is activated.

Ans: C

Feedback: Estrogen enters the cell and reacts with a receptor site inside the cell to change messenger RNA, which enters the cell nucleus to affect cellular DNA, and the final result is an alteration in the cell’s function.

Format: Multiple Selection Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 583, The Hypothalamus 16. The nurse is preparing a class on the endocrine system for students. What benefit is served by the positioning of the hypothalamus in the brain? Select all that apply. A) close to other important areas of the brain B) able to influence and be influenced by emotions and thoughts C) not isolated by the blood–brain barrier D) floats within ventricles of the brain E) protected from the limbic system

Ans: A, B, C

Feedback: Situated at the base of the forebrain, the hypothalamus receives input from virtually all other areas of the brain, including the limbic system, cerebral cortex, and the

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special senses that are controlled by the cranial nerves: smell, sight, touch, taste, and hearing. Because of its positioning, the hypothalamus is able to influence and be influenced by emotions and thoughts. The hypothalamus also is located in an area of the brain that is poorly protected by the blood–brain barrier, so it is able to act as a sensor to various electrolytes, chemicals, and hormones that are in circulation and do not affect other areas of the brain. It does not float within the ventricles of the brain, and it is located to allow input from the limbic system.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 585, The Posterior Pituitary 17. The nurse is caring for a pregnant client. What hormone must be secreted to cause uterine contractions? A) oxytocin B) prolactin C) estrogen D) enkephalins

Ans: A

Feedback: The pituitary is made up of three lobes: anterior, intermediate, and posterior. The posterior lobe stores two hormones produced by the hypothalamus, ADH and oxytocin. Oxytocin stimulates uterine smooth muscle contraction in late phases of pregnancy and also causes milk release or “let down” reflex in lactating women. The posterior lobe does not store estrogen or enkephalins. Prolactin stimulates milk production, not the onset of labor.

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Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 585, The Posterior Pituitary 18. What receptors in the body stimulate the posterior pituitary to release antidiuretic hormone (ADH)? A) diuretic receptors B) osmoreceptors C) alpha-adrenergic receptors D) nicotinic receptors

Ans: B

Feedback: The osmoreceptors in the hypothalamus stimulate the release of ADH. There is no such thing as a diuretic receptor. Alpha receptors are associated with the sympathetic nervous system, and nicotinic receptors are associated with the parasympathetic nervous system.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 583, The Hypothalamus 19. The nurse is reviewing a client’s computed tomography of a client’s head with the health care provider. Where should the nurse locate the client’s hypothalamus?

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A) adjacent to the cerebellum B) within the basal ganglia C) at the base of the pons D) at the base of the forebrain

Ans: D

Feedback: Situated at the base of the forebrain, the hypothalamus receives input from virtually all other areas of the brain, including the limbic system and the cerebral cortex. It is not situated below the pons or within the basal ganglia. It is deeper than the cerebellum, which is superficial.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4, 5 Page and Header: 586, Hypothalamic–Pituitary Axis 20. The client’s hypothalamus is responding to low serum levels of a hormone by way of a negative feedback system. What will the client’s hypothalamus do? A) increase production of the stimulating hormone B) reduce metabolic demand for the particular hormone C) respond to the input of the thyroid gland D) redirect the client’s physiologic processes Ans: A

Feedback: The fine-tuning and regulation of hormone release through the hypothalamus is often regulated by a series of negative feedback systems in which an excess causes reduced production and a deficit causes an increase in production. Therefore, low serum levels of a hormone would cause the hypothalamus to increase

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production of the stimulating hormone. The hypothalamus, not the thyroid, is the key mediator of this process. The hypothalamus does not cause a reduction in the metabolic demand and does not alter physiology to reduce demand for a hormone.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 4 Page and Header: 586, Hypothalamic–Pituitary Axis 21. To better understand the negative feedback system, what might the nurse compare it with? A) the actions of use and disuse B) the law of supply and demand C) the concept of need and use D) the contract of give and take

Ans: B

Feedback: A negative feedback system works much like the law of supply and demand in business. In business, when the supply of a product is adequate, production of that product will be cut back because demand is not there. Other options are distracters for this question.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 5 Page and Header: 586, Hypothalamic–Pituitary Axis 22. A client’s hypothalamus senses a need for thyroid hormone. Where will it secrete the releasing factor thyrotropin-releasing hormone (TRH)? A) directly into the posterior pituitary B) directly into the bloodstream C) directly into the anterior pituitary D) directly into the thyroid gland

Ans: C

Feedback: When the hypothalamus senses a need for thyroid hormone, it secretes TRH directly into the anterior pituitary, not into the posterior pituitary, the blood stream, or the thyroid gland itself.

Format: Multiple Selection Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 586, Other Forms of Regulation 23. What hormone(s) does the pancreas produce and release that help moderate the body’s varying blood glucose levels? Select all that apply. A) insulin B) antidiuretic hormone (ADH) C) glucagon D) somatostatin E) amylase

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Ans: A, C, D

Feedback: The pancreas produces and releases insulin, glucagon, and somatostatin from different cells in response to varying blood glucose levels. ADH does not respond to blood glucose levels but controls sodium and potassium levels. Amylase is an enzyme released by the pancreas.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4, 5 Page and Header: 586, Hypothalamic–Pituitary Axis 24. The hypothalamic–pituitary axis (HPA) functions through two processes to regulate hormone production. One of these processes is the negative feedback system. What is the other process? A) direct use of inhibiting factors B) indirect use of feedback loop C) direct use of releasing factors D) indirect use of stimulating factors

Ans: A

Feedback: The HPA functions through negative feedback loops or the direct use of inhibiting factors to constantly keep particular hormones regulated. Other options are incorrect because hormones are not regulated by feedback loops, releasing factors, or stimulating factors.

Format: Multiple Selection

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Chapter: 34 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 586, Hypothalamic–Pituitary Axis 25. The nurse administers an exogenous hormone to the client. How does the nurse’s action impact the endocrine system? Select all that apply. A) may disrupt the normal functioning of the hypothalamus B) may increase hormone levels in the body C) my stop production of releasing and stimulating hormones D) may lead to a decrease in the normal production of the hormone E) may make the pituitary gland unresponsive to stimuli

Ans: B, C, D

Feedback: Supplying an exogenous hormone may increase the hormone levels in the body, but then might affect the hypothalamic–pituitary axis (HPA) to stop production of releasing and stimulating hormones, leading to a decrease in the body’s normal production of the hormone. Administering hormones may cause a change in the levels of stimulating hormones that the hypothalamus releases, but it will not fundamentally disrupt the normal functioning of the hypothalamus. It would not make the pituitary gland unresponsive to stimuli.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5

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Page and Header: 586, Hypothalamic–Pituitary Axis 26. The nurse is describing the hypothalamic–pituitary axis (HPA) and what happens when a need arises to override the HPA system. What can result from this situation? A) a negative feedback system B) homeostasis C) complications D) maximum efficiency

Ans: C

Feedback: The HPA can create complications, especially when a need exists to override or interact with the total system, as is the case with replacement therapy or treatment of endocrine disorders. Interactions with the total system cannot create a negative feedback system, homeostasis, or maximum efficiency.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 583, The Hypothalamus 27. What is the connecting link between the nervous system and the endocrine system? A) hypothalamus B) thalamus C) medulla oblongata D) posterior pituitary

Ans: A

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Feedback: The main connecting link between the nervous system and the endocrine system is the hypothalamus, which responds to nervous system stimulation by producing hormones. The thalamus and medulla oblongata are part of the nervous system, and the posterior pituitary is part of the endocrine system but none of these represents a link between the two systems.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 582, Table 34.1 Endocrine Glands with Associated Hormones and Clinical Effects 28. When the nurse is assessing a client’s endocrine system, what gland will be excluded because it is not classified as a major organ of the endocrine system? A) hypothalamus B) pituitary C) thyroid D) gallbladder

Ans: D

Feedback: The gallbladder is not part of the endocrine system and does not secrete hormones. The gallbladder is a part of the gastrointestinal system and a storage site for bile. All other options are organs of the endocrine system.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation

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Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 3 Page and Header: 581, Key Terms 29. What is a releasing hormone? A) chemical that interacts with a hormone to activate it B) chemical released by the body to stimulate the hypothalamus C) chemical released by the body organs to stimulate the pituitary D) chemical released by the hypothalamus into the anterior pituitary

Ans: D

Feedback: Releasing hormones or factors are chemicals released by the hypothalamus into the anterior pituitary to stimulate the release of anterior pituitary hormones. The releasing hormone does not activate a hormone but stimulates its production. It does not stimulate the glands (hypothalamus or pituitary) but rather stimulates release of an anterior pituitary hormone.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 3 Page and Header: 583, The Hypothalamus 30. The nurse overhears a colleague talking about the “master gland.” What gland does the nurse recognize is being discussed? A) the pituitary gland B) the hypothalamus gland C) the thyroid gland

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D) the parathyroid gland

Ans: B

Feedback: Scientists now designate the hypothalamus as the master gland because it has direct regulatory effects over the neuroendocrine system, including stimulation of the pituitary gland to produce its hormones. The pituitary gland was formerly considered the master gland, but new research has helped scientists realize it is the hypothalamus that is the master gland. The thyroid and parathyroid glands have important roles in the body but are not considered the master gland.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 586, Hypothalamic–Pituitary Axis 31. The nurse administers a thyroid hormone replacement pill to the client. What effect will this action have on the client’s production of thyroid hormones? A) stimulates the gland that normally produces that hormone B) stops production of releasing and stimulating hormones C) initiates the negative feedback system D) stimulates the hypothalamic–pituitary axis

Ans: B

Feedback: Supplying an exogenous hormone may increase the hormone levels in the body, but it then may affect the hypothalamic–pituitary axis (HPA) to stop production of releasing and stimulating hormones, leading to a decrease in the body’s normal

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production of the hormone. It does not stimulate the gland or the HPA. It also does not trigger a negative feedback response.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 586, Hypothalamic–Pituitary Axis 32. What hormones do not have a target organ to produce hormones and cannot be regulated by the same feedback system as other hormones? A) growth hormone and prolactin B) estrogen and progesterone C) erythropoietin and renin D) insulin and glucagon

Ans: A

Feedback: Two of the anterior pituitary hormones (i.e., growth hormone and prolactin) do not have a target organ to produce hormones and so cannot be regulated by the same type of feedback mechanism. Estrogen and progesterone have the uterus, ovaries, and breast, as their target organs. The target organs for erythropoietin is the bone marrow; for renin, it is the arteries; and insulin and glucagon come from the pancreas to stimulate cells to metabolize glucose and regulate serum glucose levels.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand

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Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 583, The Hypothalamus 33. What qualifies the hypothalamus to be called the master gland? A) It regulates the nervous and endocrine responses to stimuli. B) It stimulates the pituitary gland to control the endocrine system. C) It combines the nervous and endocrine system to work together. D) It produces all of the releasing hormones in the body.

Ans: A

Feedback: The hypothalamus gland is called the master gland of the neuroendocrine system because it regulates both nervous and endocrine responses to internal and external stimuli. There is more to the hypothalamus than just its stimulation of the pituitary gland or its production of releasing hormones that leads it to be considered the master gland. The neuroendocrine system combines the nervous and endocrine systems to work closely together to maintain regulatory control and homeostasis in the body.

Format: Multiple Choice Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 1 Page and Header: 582, Table 34.1 Endocrine Glands with Associated Hormones and Clinical Effects 34. A client with chronic kidney failure is experiencing endocrine effects of this illness. What assessment finding would provide the clearest evidence of this client’s hormonal disruption? A) The client’s blood glucose levels are highly variable.

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B) The client experiences generalized fatigue and weakness. C) The client’s laboratory values indicate high calcium levels. D) The client’s red blood cell indices are low.

Ans: D

Feedback: The kidneys produce erythropoietin, which increases the production of red blood cells. Low red cell levels would consequently be evidence of inadequate erythropoietin levels. The client’s calcium levels and blood glucose levels would remain unaffected. The client would likely be fatigued by anemia, but the red blood cells levels are the clearest and most objective evidence.

Format: Multiple Selection Chapter: 34 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Teaching/Learning Objective: 5 Page and Header: 585, Table 34.2 Hypothalamic Hormones, Associated Anterior Pituitary Hormones, and Target Organ Response 35. Which hypothalamus hormone is associated with hormone inhibiting? A) somatostatin B) prolactin (PRL) C) adrenocorticotropic hormone (ACTH) D) luteinizing hormone (LH)

Ans: A

Feedback: Somatostatin inhibits release of growth hormone (GH). The remaining options are all associated with the stimulation of various hormones and processes.

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Test Generator Questions, Chapter 35, Hypothalamic and Pituitary Agents Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 592, Table 35.1 Drugs Affecting Hypothalamic Hormones 1. The nurse is caring for a client who receives monthly injections of goserelin. What assessment should the nurse perform when monitoring the client for therapeutic effects? A) Assess the character and severity of the client’s cancer pain. B) Assess the client’s height and plot it against age-based percentiles. C) Monitor the client’s quantity and distribution of body fat. D) Monitor the client’s level of consciousness and orientation.

Ans: A

Feedback: Goserelin is administered for the treatment of certain hormone-stimulated cancers, such as breast cancer and prostate cancer. The nurse should consequently monitor for cancer pain. Goserelin does not have a direct effect on fat distribution, growth, or LOC.

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Page and Header: 592, Table 35.1 Drugs Affecting Hypothalamic Hormones 2. A nurse has administered 250 mcg ganirelix acetate subcutaneously to a client. What result indicates successful treatment? A) The client’s cancer pain is relieved. B) The client becomes pregnant. C) The client’s breast cancer goes into remission. D) The client experiences relief from perimenopausal symptoms.

Ans: B

Feedback: Ganirelix acetate is administered subcutaneously as part of a fertility program. It is not used to treat cancer or to relieve the symptoms of menopause.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4, 5 Page and Header: 593, Prototype Summary: Leuprolide 3. A client is taking leuprolide to treat prostatic cancer. The nurse caring for this client should monitor most closely for what? A) diarrhea B) urinary retention C) peripheral edema D) increased appetite

Ans: C Feedback: Peripheral edema is an identified adverse effect of leuprolide therapy. Constipation not diarrhea, urinary frequency not urinary retention, and anorexia not increased appetite are also identified adverse effects.

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Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 593, Drugs Affecting Anterior Pituitary Hormones 4. After administering somatropin to an 11-year-old client with growth failure, what outcome would indicate that the drug should be stopped? A) early sexual development B) thyroid overactivity C) closure of the epiphyses in long bones D) gynecomastia

Ans: C

Feedback: Closure of the epiphyses is a sign that the drug should be stopped. Early sexual development, thyroid overactivity, and gynecomastia would not be associated with this drug.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 4, 5 Page and Header: 599, Drugs Affecting Posterior Pituitary Hormones 5. The nurse administers desmopressin (DDAVP) to the client to treat diabetes insipidus. What assessment finding would indicate to the nurse that the desmopressin is producing a therapeutic effect? A) decreased urine output

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B) decreased water reabsorption C) increased plasma osmolarity D) decreased blood volume

Ans: A

Feedback: Desmopressin produces its antidiuretic activity in the kidneys, causing the cortical and medullary parts of the collecting duct to become permeable to water, thereby increasing water reabsorption and decreasing urine formation. These activities reduce plasma osmolarity and increase blood volume.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 4, 5 Page and Header: 599, Drugs Affecting Posterior Pituitary Hormones 6. A client diagnosed with diabetes insipidus has been administered desmopressin (DDAVP) and is now reporting drowsiness, light-headedness, and headache. What intervention will best address this client’s symptoms? A) temporary bed rest B) STAT administration of epinephrine C) administration of a loop diuretic D) reduction in the client’s dose of desmopressin

Ans: D

Feedback: The adverse effects associated with the use of desmopressin include water intoxication (drowsiness, light-headedness, headache, coma, convulsions) related to the shift to water retention and resulting electrolyte imbalance. These symptoms warrant a reduction in dose. The use of diuretics would not resolve the client’s symptoms.

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Epinephrine would resolve anaphylaxis not water intoxication. Bed rest would have no therapeutic effect beyond ensuring physical safety.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 596, Prototype Summary: Somatropin 7. What drug would the nurse expect to administer to a client diagnosed with acquired immunodeficiency syndrome and who has developed cachexia? A) bromocriptine B) somatropin C) desmopressin D) leuprolide

Ans: B

Feedback: Indications for somatropin therapy include cachexia related to AIDS, longterm treatment of children with growth failure associated with various deficiencies, girls with Turner’s syndrome, AIDS-related wasting, growth hormone deficiency in adults, and treatment of growth failure in children of small gestational age who do not achieve catch-up growth by 2 years of age. Bromocriptine mesylate is indicated for the treatment of Parkinson’s disease, hyperprolactinemia associated with pituitary adenomas, female infertility associated with hyperprolactinemia, and acromegaly; and short-term treatment of amenorrhea or galactorrhea. Desmopressin is indicated for the treatment of neurogenic diabetes insipidus and hemophilia A. Leuprolide is used as an antineoplastic agent for treatment of specific cancers.

Format: Multiple Choice Chapter: 35

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 593, Drugs Affecting Anterior Pituitary Hormones 8. When providing health education to a client taking octreotide, the nurse should warn the client about the possibility of what potential adverse effect? A) abdominal pain B) alteration in consciousness C) changes in vision D) tinnitus

Ans: A

Feedback: Octreotide and lanreotide have commonly been associated with the development of acute cholecystitis, cholestatic jaundice, biliary tract obstruction, and pancreatitis, which would present with abdominal pain, so clients should be taught to report this symptom. The drug is not associated with alteration in consciousness, changes in vision, or tinnitus.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 591, Box 35.1 Focus on Drug Therapy across the Lifespan: Hypothalamic and Pituitary Agents: Children 9. The nurse has been caring for a child who has been receiving growth hormone therapy for several years. When the child returns for evaluation following a sudden

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growth spurt, what nursing diagnosis should the nurse most likely add to the plan of care? A) disturbed body image related to change in height B) deficient knowledge regarding drug therapy C) risk for imbalanced nutrition: less than body requirements related to metabolic changes D) decreased cardiac output related to increased metabolic needs

Ans: C

Feedback: A child who is taking growth hormone may experience sudden growth, which will require increased nutritional intake, so it is important to include nutritional needs in the plan of care. More than likely an increase in caloric intake and nutrients will be necessary. Most children who are small for their age see growth as a positive thing and not a disturbed body image. After taking the drug for several years, the client should have received adequate teaching from the nurse to make deficient knowledge unlikely. Growth would cause increased metabolic demand, but this does not lead to a decrease in cardiac output.

Format: Fill-in-the-Blank Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 4, 5 Page and Header: 592, Table 35.1 Drugs Affecting Hypothalamic Hormones 10. The nurse receives an order to administer leuprolide 50 mcg/kg subcutaneously to a child with precocious puberty. The child weighs 66 lb. What is the correct dosage for this child? Record your answer to the nearest mcg.

Ans: 1,500 mcg

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Feedback: To begin, convert the child’s weight to kilograms by dividing by 2.2: 66 ÷ 2.2 = 30. Multiply the child’s weight in kilograms times the mg/kg: 30 × 50 = 1,500 mcg/dose.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 593, Drugs Affecting Anterior Pituitary Hormones 11. The nurse is caring for a client who has been diagnosed with infertility related to hyperprolactinemia. What drug would best treat this problem? A) bromocriptine mesylate B) somatropin C) leuprolide D) desmopressin

Ans: A

Feedback: Bromocriptine mesylate is indicated for the treatment of female infertility associated with hyperprolactinemia. Somatropin is indicated for the treatment of growth failure, Turner’s syndrome, AIDS wasting and cachexia, and growth hormone deficiency in adults. Leuprolide is used as antineoplastic agent for the treatment of specific cancers and for the treatment of endometriosis and precocious puberty that results from hypothalamic activity. Desmopressin is used for the treatment of neurogenic diabetes insipidus, von Willebrand disease, and hemophilia, and is currently being studied for the treatment of chronic autonomic failure.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 4, 5 Page and Header: 600, Table 35.3 Drugs Affecting Posterior Pituitary Hormones 12. A child weighing 14.5 kg has been diagnosed with von Willebrand disease and has been prescribed desmopressin 0.3 mcg/kg IV. How much desmopressin should the nurse administer? A) 4.4 mcg B) 9.6 mcg C) 10.3 mcg D) 21.1 mcg

Ans: A

Feedback: The normal dosage of desmopressin used to treat von Willebrand disease is 0.3 mcg/kg. Multiply this dosage times the child’s weight: 14.5 kg × 0.3 mcg = 4.4 mcg.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 590, Drugs Affecting Hypothalamic Hormones 13. What is the main purpose of the hormones secreted by the hypothalamus? A) stimulating or inhibiting release of hormones from the pituitary B) stimulating organs within the body to secrete hormones C) allowing the secretion of hormones from the hypothalamus D) stimulating other glands to release hormones

Ans: A

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Feedback: The hypothalamus uses various hormones or factors to either stimulate or inhibit the release of hormones from the anterior pituitary. These do not stimulate other organs, the hypothalamus, or other glands to release hormones.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 594, Table 35.2 Drugs Affecting Anterior Pituitary Hormones 14. A 48-year-old client diagnosed with acromegaly is not a candidate for other therapy. What medication, administered subcutaneously, would the nurse caring for the client expect the health care provider to order? A) gonadorelin hydrochloride B) octreotide C) nafarelin D) gonadorelin acetate

Ans: B

Feedback: Octreotide is a treatment for acromegaly in adults who are not candidates for, or cannot tolerate, other therapy. Gonadorelin hydrochloride, nafarelin, and gonadorelin acetate are not indicated for treating acromegaly.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 1 Page and Header: 599, Drugs Affecting Posterior Pituitary Hormones 15. A client is brought to the emergency department after a motor vehicle accident. The client is hemorrhaging, indicating that which hormone is being secreted to restore blood volume? A) growth hormone (GH) B) follicle-stimulating hormone (FSH) C) antidiuretic hormone (ADH) D) adrenocorticotropic hormone (ACTH)

Ans: C

Feedback: ADH possesses antidiuretic, hemostatic, and vasopressor properties. During hemorrhage, GH, FSH, and ACTH are not involved in blood volume restoration.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 4 Page and Header: 593, Drugs Affecting Anterior Pituitary Hormones 16. The nurse is working with a child who has impaired growth due to a deficiency of endogenous growth hormone. What change in the client’s health status would contraindicate the safe and effective use of somatropin? A) The client has begun playing organized sports. B) The client is developing increased amounts of abdominal fat. C) The client has reached 5 ft in height. D) The client’s epiphyses have begun to close.

Ans: D

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Feedback: Somatropin is contraindicated in the presence of closed epiphyses; it can be given at any time before closure of the epiphyses. Height does not impact when the drug can be given, so long as the epiphyses remain open. Similarly, participation in sports and increased adipose tissue do not mean that somatropin cannot be given safely.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 598, Nursing Considerations for Patients Receiving Growth Hormone Antagonists: Intervention with Rationale 17. The nurse is caring for a client who is receiving octreotide for the treatment of acromegaly. The nurse should emphasize the need for what form of baseline and periodic testing? A) ultrasound evaluation of the gallbladder B) magnetic resonance imaging (MRI) of the brain C) serum glucose levels D) complete blood counts

Ans: A

Feedback: Arrange for baseline and periodic ultrasound evaluation of the gallbladder for clients receiving octreotide because common adverse effects of the drug are acute cholecystitis, cholestatic jaundice, biliary tract obstruction, and pancreatitis. A client taking octreotide does not need baseline and periodic MRIs of the brain, serum glucose levels, or complete blood counts.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 600, Table 35.3 Drugs Affecting Posterior Pituitary Hormones 18. The nurse is caring for a client with neurogenic diabetes insipidus and administers what drug to treat the condition? A) dexamethasone B) desmopressin C) methylprednisolone D) physostigmine

Ans: B Feedback: Synthetic preparations of antidiuretic hormone (ADH) are used to treat diabetes insipidus. Only one ADH preparation is currently available, desmopressin. Dexamethasone, methylprednisolone, and physostigmine would not be indicated for treatment of this disorder.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 593, Drugs Affecting Anterior Pituitary Hormones 19. The nurse has administered a subcutaneous injection of 250 mcg chorionic gonadotropin alpha to a client. What outcome best indicates therapeutic effects? A) The client’s urine output decreases and becomes more concentrated. B) The client become pregnant. C) The client’s height increases. D) The client’s sexual development ceases.

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Ans: B

Feedback: Chorionic gonadotropin alpha is used to induce ovulation with the ultimate goal of conception. It has no effect on fluid balance, growth, or sexual development.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 4, 5 Page and Header: 599, Drugs Affecting Posterior Pituitary Hormones 20. The nurse administers desmopressin to treat a client diagnosed with diabetes insipidus. What change in the client’s laboratory studies would indicate the drug is working? A) increased serum sodium levels B) increased red blood cell count C) decreased urine specific gravity D) reduced urine glucose levels

Ans: A

Feedback: Clients with diabetes insipidus (DI) produce large amounts of dilute urine with a decrease in serum sodium levels. Administering desmopressin would reduce urine output and allow sodium levels to rise. Urine specific gravity would increase as the urine production slows and urine becomes more concentrated. There is no impact on red blood cell production with diabetes insipidus or its treatment. The urine of a client with DI does not normally contain glucose.

Format: Multiple Selection Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 599, Drugs Affecting Posterior Pituitary Hormones 21. The nurse would administer desmopressin cautiously, with close monitoring, to the client with what comorbidities? Select all that apply. A) hyponatremia B) asthma C) severe renal dysfunction D) gastrointestinal (GI) disease E) vascular disease

Ans: A, B, E

Feedback: Caution should be used with any known vascular disease because of its effects on vascular smooth muscle, asthma, and with hyponatremia, which could be exacerbated by the effects of the drug. The drug is contraindicated and should not be used in clients with severe renal dysfunction. GI disease is not a caution or contraindication.

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B) acute pain related to administration of injections C) imbalanced nutrition: more than body requirements related to increased appetite D) risk for unplanned pregnancy

Ans: B

Feedback: Nursing diagnoses related to drug therapy might include acute pain related to need for injections. This medication does not normally cause diuresis. The client is more likely to have reduced nutritional intake because of gastrointestinal (GI) adverse effects. GHRH has no direct effect on conception.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4, 5 Page and Header: 595, Adverse Effects 23. When providing client teaching to the family of a 12-year-old child who is receiving somatropin, the nurse stresses the need to notify prescriber if what manifestation occurs? A) severe hip or knee pain B) upper respiratory infection lasting more than 6 days C) nosebleeds D) dry skin accompanied by pruritus

Ans: A

Feedback: The adverse effects that most often occur when using a growth hormone (GH) include the development of antibodies to GH and subsequent signs of inflammation and autoimmune-type reactions, such as swelling and joint pain including myalgia and arthralgia. It would not be necessary to notify the health care provider for development

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of an upper respiratory infection or nosebleeds. Dry skin and pruritus are unlikely to warrant medical follow-up.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 592, Table 35.1 Drugs Affecting Hypothalamic Hormones 24. What medication would the nurse expect the provider to prescribe as palliative treatment for advanced prostate cancer? A) histrelin B) ganirelix C) nafarelin D) somatropin

Ans: A

Feedback: Histrelin is used to provide palliative treatment for advanced prostate cancer. Nafarelin is used for treatment of endometriosis and precocious puberty; ganirelix is used for inhibition of premature luteinizing hormone surge in women undergoing controlled ovarian stimulation as part of a fertility program; somatropin is used for treatment of children with growth failure due to lack of growth hormone or to chronic renal failure.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process

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Objective: 1, 3 Page and Header: 593, Drugs Affecting Anterior Pituitary Hormones 25. A 4-year-old child is tested and found to have deficient growth hormone (GH). What does this condition cause? A) gigantism B) acromegaly C) syndrome of inappropriate antidiuretic hormone (SIADH) D) dwarfism

Ans: D

Feedback: GH deficiency in children results in short stature (dwarfism). Excess production of GH results in gigantism and acromegaly. SIADH is caused by excessive production of antidiuretic hormone.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 599, Drugs Affecting Posterior Pituitary Hormones 26. What hormone does the posterior pituitary gland store and release? A) antidiuretic hormone (ADH) B) follicle-stimulating hormone (FSH) C) growth hormone (GH) D) thyroid-stimulating hormone (TSH)

Ans: A

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Feedback: The posterior pituitary stores two hormones produced in the hypothalamus: ADH, also known as vasopressin, and oxytocin. The posterior pituitary does not store FSH, GH, or TSH.

Format: Multiple Selection Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 590, Drugs Affecting Hypothalamic Hormones 27. For what purpose(s) might the nurse administer a hypothalamic hormone? Select all that apply. A) diagnostic testing B) synthesis of growth factors C) prevent aging D) treating some forms of cancer E) adjuncts in fertility programs

Ans: A, D, E

Feedback: The hypothalamic hormones are not all available for pharmacological purposes. Those available are used mostly for diagnostic testing, for treating some forms of cancer, or as adjunctive therapies in fertility programs. They would not be used to prevent aging or for the synthesis of growth factor.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 1 Page and Header: 599, Drugs Affecting Posterior Pituitary Hormones 28. The nurse is caring for a trauma client who presents with total body edema and scant urine output. The nurse should recognize the effects of what endocrine disruption? A) excessive secretion of antidiuretic hormone B) insufficient secretion of antidiuretic hormone C) excessive secretion of androgens D) acute growth hormone deficiency

Ans: A

Feedback: This client’s presentation is suggestive of syndrome of inappropriate antidiuretic hormone. SIADH occurs with excessive secretion of ADH. Insufficient secretion of ADH causes diabetes insipidus, which is the opposite problem. ADH is not related to androgenic actions or a decrease in growth hormone levels.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 599, Drugs Affecting Posterior Pituitary Hormones 29. How should the nurse best explain the role of the posterior pituitary gland? A) “It synthesizes different hormones.” B) “It makes two different hormones.” C) “It stores hormones that are produced in your brain.” D) “It controls many of the metabolic functions of the body.”

Ans: C

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Feedback: The posterior pituitary stores two hormones produced in the hypothalamus: antidiuretic hormone (ADH, also known as vasopressin) and oxytocin. The posterior pituitary is anatomically an extension of the hypothalamus and is composed mainly of nerve fibers. Although it does not manufacture any hormones itself, it stores and releases hormones synthesized in the hypothalamus. The hypothalamus of the brain and the pituitary gland interact together to control most metabolic functions of the body and to maintain homeostasis.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 599, Drugs Affecting Posterior Pituitary Hormones 30. The nurse is caring for a client who is receiving tolvaptan and digoxin. When assessing for drug–drug interactions, the nurse should prioritize what laboratory result? A) creatinine level B) digoxin level C) serum potassium level D) hematocrit

Ans: C

Feedback: Tolvaptan should be used with care with digoxin, which could cause hyperkalemia, so the nurse must carefully monitor serum potassium levels. The combination of drugs would not cause reduced digoxin levels, changes in creatinine levels, or changes in hematocrit.

Format: Multiple Selection Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 591, Box 35.1 Focus on Drug Therapy across the Lifespan: Hypothalamic and Pituitary Agents: Children 31. The nurse is caring for a client who has been receiving long-term growth hormone treatment to stimulate growth. What diagnostic testing would the nurse expect to see ordered as a standard part of the treatment plan? Select all that apply. A) blood sugar level B) serum electrolytes C) x-ray of the long bones D) liver enzyme levels E) computed tomography of the head

Ans: A, B, C

Feedback: Periodic radiography of the long bones, as well as monitoring of blood sugar levels and electrolytes, should be a standard part of the treatment plan for children who receive any of the hypothalamic or pituitary agents. Growth hormone would not be expected to impact liver function. There would be no obvious indication for a CT of the head, which is usually used to visualize the brain.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 591, Box 35.1 Focus on Drug Therapy across the Lifespan: Hypothalamic and Pituitary Agents: Older Adults

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32. What is the nurse’s priority assessment when administering hypothalamic or pituitary agents to older adults? A) hydration and nutrition B) balance and fall risk C) cognitive function and adherence to treatment D) bowel function

Ans: A

Feedback: Older adults may be more susceptible to the imbalances associated with alterations in the endocrine system. They should be evaluated periodically during treatment for hydration and nutrition, as well as for electrolyte balance. These drugs would not be expected to impact balance, cognitive function, or to disrupt bowel function, so these would not be the priority assessment.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Communication and Documentation Objective: 3 Page and Header: 595, Box 35.2 Treatment for Growth Failure in Children 33. The parent of a child awaiting a renal transplant asks the nurse whether growth hormone could be effective for the child. What is the nurse’s best response? A) “Growth hormone is only used to treat short stature in children who do not produce enough growth hormone naturally.” B) “Growth hormone has been used successfully in children with renal failure, but there is a lot to consider, and you should talk to the doctor about it.” C) “Administration of growth hormone requires frequent injections, so it would be very painful for a child with existing medical problems.” D) “You do not want to use growth hormone if you do not have to, because there are serious adverse effects that go along with it.”

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Ans: B

Feedback: Growth hormone therapy is used with children with renal failure, but the decision carries risks as well as benefits, so it is important for the mother to talk to the child’s primary provider and nephrologist to get recommendations for its safety. It is not just used in children with inadequate growth hormone secretion. The nurse should avoid characterizing it as “very painful” and should not strongly dissuade the parent from exploring options.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 4, 5 Page and Header: 594, Table 35.2 Drugs Affecting Anterior Pituitary Hormones 34. The nurse is asked to explain how to administer somatropin to the parent of a 6year-old child. How would the nurse explain how this drug is administered? A) “It requires only a very small needle and doesn’t hurt much at all.” B) “There will no longer be any need to rotate sites because it is given only weekly.” C) “The medication can be given orally until your child gets older and is more tolerant of needles.” D) “The medication must be delivered daily either subcutaneously or by IM injects.”

Ans: D

Feedback: Somatropin must be given subcutaneously or IM daily. Dose varies based on indication and product, so it is important to check manufacturer’s instructions. Suggesting that the administration “doesn’t hurt much” is not therapeutic. Format: Multiple Choice Chapter: 35

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 592, Table 35.1 Drugs Affecting Hypothalamic Hormones 35. A 9-year-old female client has been prescribed nafarelin 1,600 mcg nasal spray daily. What assessment should the nurse prioritize when following up this client’s treatment? A) assessing for signs and symptoms of excess fluid volume B) assessing the client’s cognition and orientation C) assessing the client’s height and body mass index D) assessing for the development of secondary sex characteristics

Ans: D

Feedback: Nafarelin is administered for the treatment of precocious puberty. As a result, the nurse’s assessment should focus on whether the client is developing secondary sex characteristics. The goal of therapy is to delay their development. Fluid volume, cognition, and body mass are not normally affected.

Format: Multiple Choice Chapter: 35 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyzing Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 3, 5 Page and Header: 591, Box 35.1 Focus on Drug Therapy across the Lifespan: Hypothalamic and Pituitary Agents: Older Adults 36. What is the primary reason that the older adult client requires dosage adjustments when prescribed leuprolide? A) chronic respiratory issues

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B) poor medication adherence C) cognitive impairment D) age-related hepatic changes

Ans: D

Feedback: Leuprolide, a GnRH agonist, is prescribed as treatment of advanced prostatic cancer, endometriosis, central precocious puberty, uterine leiomyomata. This class of medication requires dosing adjustments with renal or hepatic impairment that occur since older adults have higher potential for these impairments. Respiratory issues neither chronic nor acute play a significant role in dosage adjustment of a GnRH agonist. While cognitive impairment and poor medication adherence may be issues for the older adult client neither is the primary reason for dosage adjustment of the medication.

Test Generator Questions, Chapter 36, Adrenocortical Agents Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 4, 5 Page and Header: 618, Mineralocorticoids, Prototype Summary: Fludrocortisone 1. The nurse administers fludrocortisone to a client who has been diagnosed with saltlosing adrenogenital syndrome and then assesses for evidence of what therapeutic action? A) increased level of consciousness and elevated serum glucose level B) increased sodium and water reabsorption and potassium excretion C) increased output of dilute urine and resolution of peripheral edema D) potassium retention and increased serum calcium levels

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Ans: B

Feedback: Fludrocortisone’s therapeutic effects include an increase in sodium and water reabsorption with increased excretion of potassium. Glucose levels and calcium levels are not normally impacted. Increased output of dilute urine would indicate a decline in the client’s condition.

Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 614, Nursing Conclusions 2. When developing a plan of care for the client receiving a glucocorticoid, what nursing diagnosis should be of highest priority? A) deficient fluid volume related to water retention B) risk for injury related to muscle weakness C) imbalanced nutrition: less than body requirements D) risk for infection related to immunosuppression

Ans: D

Feedback: Risk for infection related to immunosuppression would be the appropriate nursing diagnosis because steroids suppress the immune system, which puts the client at risk for infection. Nutritional imbalance is more likely to be “more than body requirements” than “less than body requirements.” Excess fluid volume is more appropriate than deficient fluid volume. Glucocorticoids are not associated with muscle weakness.

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Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 611, Table 36.3 3. What glucocorticoid is limited to oral administration? A) cortisone B) hydrocortisone C) prednisone D) triamcinolone Ans: C

Feedback: Prednisone is available in oral form only and is used for replacement therapy for adrenal insufficiency and treatment of allergic and inflammatory disorders. Cortisone can be administered orally or intramuscularly and is used for replacement therapy. Hydrocortisone, used for replacement therapy, is administered by the oral, IV, intramuscular, topical, ophthalmic, rectal, and intra-articular routes. Triamcinolone is administered by the oral, intramuscular, inhalant, intra-articular, and topical routes and is used for treatment of allergic and inflammatory disorders and in the management of asthma.

Format: Multiple Selection Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 610, Box 36.4

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4. The parent of an infant asks the nurse for a steroid cream for the treatment of diaper rash. What teaching should the nurse provide the parent? Select all that apply. A) “Topical corticosteroids have actually been found to make diaper rashes worse, not better.” B) “The area where you apply a topical corticosteroid should not be tightly covered with a diaper.” C) “Topical corticosteroids should not be applied to any open sores or broken skin.” D) “In general, the use of topical corticosteroids should be limited in children.” E) “Topical corticosteroids should be applied in a thick coat to the rash in order to be effective.”

Ans: B, C, D

Feedback: Topical use of corticosteroids should be limited in children because their body surface area is comparatively large and the amount of the drug absorbed in relation to weight is greater than in an adult. When the medication is used in children, it should be applied sparingly and the area should not be occluded with a diaper. There is no evidence that corticosteroids exacerbate diaper rash.

Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 614, Intervention with Rationale 5. An older adult client who is taking high-dose corticosteroids to treat arthritis requests a measles vaccine. What is the nurse’s best response? A) “Measles vaccines are only given if you are at risk for serious complications of the disease.”

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B) “Live virus vaccines cannot be given to people whose immune systems are suppressed.” C) “Clients taking corticosteroids are well protected from viruses and do not need vaccines.” D) “Corticosteroids interact with the measles vaccine to create serious adverse effects.”

Ans: B

Feedback: Corticosteroids block the inflammatory response and are very helpful in conditions such as arthritis. However, they also block the immune response, making a person immunosuppressed. The vaccine would not be given to this client because of the increased risk for infection. Vaccination against measles is universally recommended. Corticosteroids do not protect against viruses. The vaccine is contraindicated because of risk for infection and not because of a potential drug–drug interaction.

Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1, 5 Page and Header: 618, Interventions with Rationale 6. A client who is steroid dependent due to adrenocortical insufficiency calls the clinic and is very upset, reporting stressful circumstances. What does the nurse expect the health care provider will order concerning the client’s medication? A) The dosage may continue as ordered. B) The medication may be discontinued until stress declines. C) The dosage of the medication may be increased. D) The dosage of the medication may be decreased.

Ans: C

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Feedback: The client’s body will initiate a stress reaction. Normally, activation of the stress reaction can cause release of adrenocorticotropic hormone (ACTH) and secretion of the adrenocortical hormones. A client with adrenocortical insufficiency may not be able to supplement the increased need for ACTH. The stress reaction may block the immune and inflammatory systems, making the body more susceptible to pathogens. Therefore, an increase in medication may be necessary to prevent further adrenal insufficiency and to meet the increased demands for corticosteroids in the body under stress.

Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 614, Clinically Important Drug–Drug Interactions 7. A nurse is providing client education to a client who has had glucocorticoids prescribed. What drug should the nurse teach the client to avoid while taking the corticosteroids? A) aspirin B) dimenhydrinate C) phenytoin D) famotidine

Ans: A

Feedback: Serum levels and effectiveness may decrease if glucocorticoids are combined with anticoagulants like aspirin. Dimenhydrinate, phenytoin, and famotidine have not been found to produce drug–drug interaction.

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Format: Multiple Selection Chapter: 36 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 607, The Adrenal Glands, Controls 8. The nurse is caring for a client with a heightened stress response following a series of difficult circumstances. When assessing this client, what findings will the nurse attribute to this response? Select all that apply. A) elevated serum blood glucose B) reduced inflammatory response C) heightened immune response D) increased blood volume E) extreme hunger

Ans: A, B, D

Feedback: The stress response causes an increase in blood volume and a release of glucose for energy. It also slows the rate of protein production and blocks the activities of the inflammatory and immune systems, which reserves energy. This client is unlikely to be hungry.

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Page and Header: 614, Intervention with Rationale 9. The nurse is providing education to a client who is taking a glucocorticoid. The nurse should advise the client to take the medication at what time of the day, unless otherwise instructed? A) at bedtime B) with the noon meal C) about midafternoon D) first thing in the morning

Ans: D

Feedback: Glucocorticoids should be taken immediately on awaking in the morning to mimic the normal diurnal pattern. The peak levels of cortisol usually come between 6:00 and 8:00 a.m.. The levels then fall off slowly and reach a low in the late evening with the lowest levels around midnight. For those clients who work night shifts, the schedule would be changed to accommodate their sleep pattern. Waiting until later in the day could result in sleeplessness.

Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 609, Glucocorticoids; 611, Table 36.3 10. An 8-year-old client diagnosed with asthma will be prescribed triamcinolone. What should the nurse teach the client and family about the use of this medication? A) The client will be required to take one inhalation, first thing in the morning. B) The client will be unable to receive any vaccinations while taking triamcinolone. C) The client will need to be on protective isolation until the completion of treatment. D) The dose and frequency will be individualized, based on the client’s needs.

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Ans: D

Feedback: Pediatric dosage is individualized based on severity and response. However, children between 6 and 12 years of age are generally prescribed one to two inhalations t.i.d. or q.i.d. Vaccinations are not absolutely contraindicated. The use of inhaled steroids creates a slight increase in the risk for infection, but protective isolation is not necessary.

Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 607, The Adrenal Glands, Controls 11. The nurse, caring for a client who is experiencing stress, knows that activation of the stress reaction will initially cause the release of what? A) glucose B) aldosterone C) adrenocorticotropic hormone (ACTH) D) oxytocin

Ans: C

Feedback: Activation of the stress reaction through the sympathetic nervous system bypasses the usual diurnal rhythm and causes release of ACTH and secretion of the adrenocortical hormones—an important aspect of the stress (“fight-or-flight”) response. Glucose will eventually be released to supply energy, but first ACTH and adrenocortical hormones must stimulate this response. Aldosterone can be released without ACTH stimulation when the blood surrounding the adrenal gland is high in potassium. This is a

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direct stimulus for aldosterone release. Oxytocin is released to promote the let-down reflex in the lactating woman and to stimulate uterine contractions but is not involved in the stress response.

Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 613, Glucocorticoids, Contraindications and Cautions 12. The nurse is developing a plan of care for an 84-year-old client who has been diagnosed with diabetes and is receiving oral hydrocortisone 40 mg daily for treatment of arthritis. What is the nurse’s priority? A) increasing carbohydrates in the client’s diet B) restricting the client’s protein intake C) increasing fluids to 2,000 mL/d unless contraindicated D) monitoring blood glucose levels frequently

Ans: D

Feedback: Caution should be used in clients with diabetes because the glucoseelevating effects disrupt glucose control. More frequent blood sugar monitoring is this client’s priority assessment, especially given the client’s age. Carbohydrate, protein, and fluid intake do not need to be altered in order to prevent adverse effects.

Format: Multiple Selection Chapter: 36 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 609, The Adrenal Glands, Adrenal Crisis 13. A client diagnosed with adrenal insufficiency has been admitted to the intensive care unit in adrenal crisis. What assessment findings support this diagnosis? Select all that apply. A) physiological exhaustion B) hypertension C) fluid shift D) shock E) septicemia

Ans: A, C, D

Feedback: Symptoms of adrenal crisis include physiological exhaustion, hypotension, fluid shift, shock, and even death. Hypotension rather than hypertension would be expected. Septicemia is a possible cause of adrenal crisis, not a symptom.

Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 614, Intervention with Rationale 14. The nurse is providing discharge teaching for a client who has been prescribed prednisone to be taken on alternate days. The client asks why they cannot just take half a pill every day. What rationale should the nurse describe? A) to eliminate adverse side effects B) to prolong therapeutic effects

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C) to prevent steroid tolerance D) to decrease adrenal suppression

Ans: D

Feedback: Alternate-day maintenance therapy is used with short-acting drugs whenever possible to decrease the risk of adrenal suppression. Alternate-day therapy would not eliminate adverse effects or prolong therapeutic effects. There is no such thing as steroid tolerance.

Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 610, Corticosteroids, Box 36.4 15. The clinic nurse receives a call from the parent of a 2-year-old child on long-term corticosteroid therapy saying that the child woke up with a cold and is pulling on their ear. What instructions should the nurse provide? A) “Encourage fluids and monitor your child’s temperature.” B) “The safest thing to do is to take your child to the emergency room (ER) immediately.” C) “Bring your child to the clinic to be seen today.” D) “This is likely an adverse effect of the steroids, so just monitor it closely and keep us posted.”

Ans: C

Feedback: Children receiving long-term therapy should be protected from exposure to infection. If infections do occur, the child should be seen by a primary care provider as

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soon as possible. This child’s symptoms suggest otitis media. There is no need to treat this as an emergency. The parent does not need to rush the child to the ER and should be encouraged to have the child seen today at the clinic instead. It would not be appropriate to give home care instructions until the child has been seen at the clinic.

Format: Multiple Selection Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 613, Adverse Effects of Corticosteroid Use Associated with Various Routes of Administration, Box 36.5 16. When doing a shift assessment on the client, the nurse would report what symptoms as a possible adverse effect of intranasal methylprednisolone? Select all that apply. A) headache B) impaired wound healing C) epistaxis D) hypotension E) nasal irritation

Ans: A, C, E

Feedback: Intranasal administration of hydrocortisone can result in headache, nausea, nasal irritation, fungal infections, epistaxis, rebound congestion, perforation of the nasal septum, anosmia, and urticaria. Systemically administered hydrocortisone has many possible adverse effects including impaired wound healing and hypotension, but these would not be likely to be associated with intranasal administration of hydrocortisone.

Format: Multiple Choice

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Chapter: 36 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1, 5 Page and Header: 618, Intervention with Rationale 17. The nurse is providing dietary teaching to the client on long-term mineralocorticoid therapy. What should the nurse teach the client? A) “Try to identify and avoid hidden sources of sodium in your diet.” B) “Make sure to include dairy products, leafy green vegetables, and other high-calcium foods in your diet.” C) “Include vitamin D supplements in your diet if you’re not getting a lot of sunlight.” D) “Eat plenty of bananas, avocados, and other foods that are high in potassium.”

Ans: D

Feedback: Mineralocorticoids cause sodium and water retention and potassium excretion. These clients benefit from a diet with increased potassium to prevent hypokalemia. They would not decrease sodium intake as the drug is often administered for the purpose of increasing serum sodium levels. Calcium and vitamin D needs would be the same for this client as any other client of similar age and gender.

Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 610, Therapeutic Actions and Indications

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18. The nurse anticipates an order for a glucocorticoid when caring for a client with what condition? A) hypoglycemia B) appendicitis C) arthritis D) septicemia

Ans: C

Feedback: Glucocorticoids are indicated for the short-term treatment of many inflammatory disorders, to relieve discomfort, and to give the body a chance to heal from the effects of inflammation. They block the actions of arachidonic acid, which leads to a decrease in the formation of prostaglandins and leukotrienes. Without these chemicals, the normal inflammatory reaction is blocked. Hypoglycemia would more safely be treated with glucose. Appendicitis and septicemia are infections that would contraindicate the use of glucocorticoids because of the immunosuppressant effects of the drugs.

Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 614, Intervention with Rationale 19. A 2-year-old client is placed on a course of prednisone following a series of hypersensitivity responses. What instruction the nurse provide the client’s family about this drug? A) “You might find that your child is sleepier than usual, especially near the beginning of treatment.”

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B) “The child may receive immunizations while on this drug, but keep them to a minimum.” C) “Don’t stop this medication suddenly; you will have to taper dosage gradually.” D) “Monitor your child closely for any difficulty swallowing or signs of gastric reflux.”

Ans: C

Feedback: Prednisone is usually ordered for short-term use with tapering dosage. It is important to instruct the parent to taper doses and to not just stop the drug suddenly when discontinuing from high doses so as to give the adrenal glands a chance to recover and produce adrenocorticoids. Parents should also be told to wait to have the child immunized until after drug therapy is completed. Insomnia or agitation is more likely than drowsiness, and the drug does not create a risk for dysphagia or reflux.

Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 614, Intervention with Rationale 20. When caring for a client who is receiving long-term therapy with corticosteroids, the nurse would plan care incorporating interventions aimed at preventing what? A) allergies B) cognitive changes C) infection D) anemia

Ans: C

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Feedback: When planning care for a client taking long-term corticosteroid therapy, the nurse needs to incorporate interventions aimed at reducing risk of infection because the client’s immune system will be suppressed, which places the client at increased risk. The drug is not associated with causing allergies, cognitive changes, or anemia.

Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 613, Adverse Effects of Corticosteroid Use Associated with Various Routes of Administration, Box 36.5 21. A 66-year-old client is on long-term oral glucocorticoid therapy to treat chronic obstructive pulmonary disease. When providing drug teaching, the nurse will inform this client that there is a particularly high risk for what? A) hyponatremia B) spontaneous fractures C) respiratory depression D) ineffective temperature regulation

Ans: B

Feedback: Only spontaneous fractures are considered an adverse effect of glucocorticoids; this client would be at increased risk because their age puts them at higher risk for osteoporosis, which also has the adverse effect of spontaneous fractures. Long-term glucocorticoid therapy is not associated with hyponatremia, respiratory depression, or ineffective temperature regulation.

Format: Multiple Choice

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Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 618, Mineralocorticoids, Prototype Summary: Fludrocortisone 22. The nurse is providing care for a client who has been taking fludrocortisone for the treatment of hypotension. What assessment finding would suggest that the client is experiencing adverse effects? A) The client has fine crackles on lung auscultation. B) The client’s potassium level is 3.7 mmol/L (3.7 mEq/L). C) The client has been having frequent, loose bowel movements. D) The client’s neutrophil level is 7.0 × 109/L (7,000/µL). Ans: A

Feedback: The increased blood volume and edema associated with mineralocorticoids can lead to adventitious lung sounds associated with heart failure. This client’s neutrophil and potassium levels are well within reference ranges. Diarrhea is not a noted adverse effect of fludrocortisone.

Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 610, Focus on Drug Therapy Across the Lifespan, Box 36.4 23. The home health nurse provides client teaching to a client who is taking oral prednisolone. The nurse provides what instruction to the client? A) “Take it first thing in the morning.”

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B) “Take 1 hour before meals.” C) “Take before bedtime.” D) “Split the dose into two equal doses.”

Ans: A

Feedback: Timing is dictated by frequency of administration, and if only taken once daily, the medication should be taken in the morning (so bedtime is inappropriate). Splitting the dose would decrease effectiveness and would be inappropriate for the nurse to suggest because it is outside the scope of nursing practice. Taking the medication before meals would mean it was being taken on an empty stomach, which can cause gastric upset.

Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 610, Corticosteroids, Box 36.4 24. What would be important for the nurse to teach the parents of a pediatric client about the use of topical corticosteroids? A) “Apply the medication sparingly.” B) “Apply directly to open lesions.” C) “After applying, cover with a bandage.” D) “Reapply as often as needed to keep the rash coated with the medication.”

Ans: A

Feedback: Topical use of corticosteroids should be limited in children, because their body surface area is comparatively large, so that the amount of the drug absorbed in relation to weight is greater than in an adult. Apply sparingly and do not use in the

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presence of open lesions. Do not occlude treated areas with dressings or diapers, which may increase the risk of systemic absorption.

Format: Multiple Choice Chapter: 36 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 610, Corticosteroids, Box 36.4 25. The nurse is teaching a client who will require long-term corticosteroid therapy how to reduce the risk of infection. What suggestions will the nurse include? A) “Avoid large crowds of people in confined spaces.” B) “Avoid working in areas with other people.” C) “Avoid exercising to reduce risk of injury.” D) “Avoid touching other people who may carry germs.”

Ans: A

Feedback: With long-term therapy, the importance of avoiding exposure to infection— crowded areas, people with colds or the flu, activities associated with injury—should be stressed. If an injury or infection should occur, the client should be encouraged to seek medical care. These clients do not need to avoid work, exercise, or touching others, but they should use good hand hygiene to avoid infection from these sources.

Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 613, Glucocorticoids, Contraindications and Cautions 26. The nurse is caring for a diabetic client who received a kidney transplant and is taking methylprednisolone for immunosuppression. What is the nurse’s priority assessment specific to this client? A) assessing capillary refill time B) assessing cardiac rhythm C) assessing red blood cell count D) assessing blood glucose levels Ans: D

Feedback: Caution should be used in clients with diabetes because the glucoseelevating effects disrupt glucose control diabetes mellitus. A priority intervention with this client is monitoring blood glucose levels. Assessment of capillary refill time and cardiac rhythm would not be indicated by the data supplied about this client. Red blood cell counts are less likely to have affected this client.

Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 606, The Adrenal Glands 27. The nurse is caring for a client who is diagnosed with protein-deficient malnutrition. Why would an order to administer androgens to this client be appropriate? A) Androgens reduce the body’s requirement for protein. B) Androgens increase the body’s absorption of protein from the bowel. C) Androgens stimulate protein production and decrease protein breakdown. D) Androgens reduce carbohydrate metabolism and promote lipid absorption.

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Ans: C

Feedback: Androgens are a form of the male sex hormone called testosterone. They affect electrolytes, stimulate protein production, and decrease protein breakdown, which will help to reverse the client’s protein malnutrition, in addition to a high-protein diet. They do not reduce the body’s need for protein, increase protein absorption from the bowel, or impact carbohydrate and lipid metabolism. Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1, 2 Page and Header: 606, The Adrenal Glands; 607, Box 36.1 28. The nurse is caring for a client who works night shift from 22:00 to 06:00 and normally sleeps from 08:00 (8 a.m.) until 16:00 (4 p.m.) each day. The nurse should teach this client to take the prescribed corticosteroid at what time of the day? A) 06:00 B) 08:00 C) 16:00 D) 22:00

Ans: C

Feedback: If a person works all night and goes to bed at 08:00, arising at 16:00 to carry on the day’s activities before going to work at 22:00, the hypothalamus will release corticotropin-releasing hormone at about 16:00 in accordance with the new sleep–wake cycle. It usually takes 2 or 3 days for the hypothalamus to readjust. A client on this schedule who is taking replacement corticosteroids would then need to take them at 16:00, or on arising.

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Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1, 2 Page and Header: 606, The Adrenal Glands 29. For what reason might a nurse administer androgen injections to a 9-year-old boy? A) ovarian atrophy B) dwarfism C) acromegaly D) hypogonadism

Ans: D

Feedback: Androgens are used pharmacologically to treat hypogonadism or to increase protein growth and red blood cell production. Androgens are not used in a male to treat ovarian atrophy. Androgens are not used to treat dwarfism or acromegaly.

Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1, 2 Page and Header: 608, Adrenal Insufficiency 30. A client is taking low-dose corticosteroids on a long-term basis for chronic obstructive pulmonary disease. The nurse assesses this client knowing prolonged use of corticosteroids puts the client at risk for what?

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A) adrenal storm B) adrenal atrophy C) stunted growth D) hypothalamic insufficiency

Ans: B

Feedback: Prolonged use of corticosteroids suppresses the normal hypothalamic– pituitary axis and leads to adrenal atrophy from lack of stimulation. The other options are all distracters for this question with no connection to long-term use of corticosteroids.

Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 614, Glucocorticoids, Prototype Summary: Prednisone 31. The nurse administers prednisone orally at 08:00. When would the nurse expect the drug to reach peak effect? A) 09:00 to 10:00 B) 12:00 to 13:00 C) 08:30 to 09:00 D) 14:00 to 15:00

Ans: A

Feedback: Prednisone’s peak effect occurs 1 to 2 hours after administering the drug. If given at 08:00, the expected peak would occur between 09:00 and 10:00.

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Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 613, Adverse Effects of Corticosteroid Use Associated with Various Routes of Administration, Box 36.5 32. Nursing care for the postoperative client requiring long-term glucocorticoid therapy will be directed at overcoming what adverse effect of the drug? A) impaired wound healing B) inflammation C) autoimmune response D) lack of mobility

Ans: A

Feedback: Clients taking long-term glucocorticoid therapy will have impaired wound healing so nursing care is directed toward promoting healing. The drug has an antiinflammatory effect so that would not need to be overcome. There is no autoimmune response or lack of mobility so these do not have to be overcome.

Format: Multiple Selection Chapter: 36 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 610, Glucocorticoids, Therapeutic Actions and Indications

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33. The nurse is caring for a client who is being treated with glucocorticoids. When reviewing the client’s latest laboratory findings, what should the nurse focus on? Select all that apply. A) sodium B) phosphorus C) chloride D) potassium E) calcium

Ans: A, D

Feedback: The glucocorticoids increase sodium reabsorption in renal tubules, leading to sodium and water retention, and increase potassium excretion. For this reason, the nurse must closely monitor the client’s sodium and potassium levels. Phosphorus, chloride, and calcium levels are less likely to be affected.

Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 606, The Adrenal Glands 34. What hormones does the adrenal medulla secrete? A) renin and erythropoietin B) norepinephrine and epinephrine C) epinephrine and dopamine D) dopamine and serotonin

Ans: B

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Feedback: The adrenal medulla is actually part of the sympathetic nervous system (SNS). It is a ganglion of neurons that releases the neurotransmitters norepinephrine and epinephrine into circulation when the SNS is stimulated.

Format: Multiple Choice Chapter: 36 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 607, Controls 35. The adrenal cortex responds to adrenocorticotropic hormone (ACTH), which responds to corticotropin-releasing hormone (CRH) from the hypothalamus in a daily pattern called what? A) pituitary rhythm B) hypothalamic–pituitary axis C) diurnal rhythm D) circadian rhythm

Ans: C

Feedback: The adrenal cortex responds to ACTH released from the anterior pituitary. ACTH, in turn, responds to CRH released from the hypothalamus. This happens regularly during a normal day in what is called “diurnal rhythm.” Pituitary rhythm is a distracter; the term does not exist. The hypothalamic–pituitary axis involves the interaction between the two glands. Circadian rhythm involves when people prefer to be most active, such as people who say they are “morning people.”

Format: Multiple Choice Chapter: 36

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Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 611, Table 36.3, Drugs in Focus: Adrenocortical Agents 36. When a client is prescribed triamcinolone for adrenal insufficiency, the nurse will anticipate providing client education regarding what topic? A) signs of sympathetic ophthalmia B) addition of mineralocorticoid therapy C) a decrease in white blood cell count (WBC) D) contraindicated during pregnancy

Ans: B

Feedback: Triamcinolone, a glucocorticoid, is prescribed treatment for allergic and inflammatory disorders, management of asthma, and of adrenal insufficiency when combined with a mineralocorticoid. Triamcinolone is a treatment for sympathetic ophthalmia. The white blood cell count often will increase in people treated with glucocorticoids such as triamcinolone. The glucocorticoids are known to cross the placenta and to enter human milk; they should be used during pregnancy and lactation only if the benefits to the client clearly outweigh the potential risks to the fetus or neonate.

Test Generator Questions, Chapter 37, Thyroid and Parathyroid Agents Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 1 Page and Header: 623, The Thyroid Gland, Control 1. The nurse is working with a client who is newly diagnosed with hypothyroidism. Diagnostic testing has indicated that the client’s health problem is caused by anterior pituitary dysfunction. This client’s hypothyroidism is rooted in a deficiency of what hormone? A) thyrotropin-releasing hormone (TRH) B) thyroid-stimulating hormone (TSH) C) tetraiodothyronine D) triiodothyronine

Ans: B

Feedback: Thyroid hormone production and release are regulated by the anterior pituitary hormone called thyroid-stimulating hormone (TSH). The secretion of TSH is regulated by thyrotropin-releasing hormone (TRH), a hypothalamic regulating factor. A client who has adequate levels of TRH will still have deficient TSH if the anterior pituitary is not functioning correctly. Tetraiodothyronine and triiodothyronine are thyroid hormones produced by the thyroid gland because of TSH stimulation.

Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 2, 3 Page and Header: 624, Thyroid and Parathyroid Agents, Children 2. A child is diagnosed with hypothyroidism. The nurse anticipates an order for what drug of choice when treating children? A) liothyronine B) liotrix

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C) levothyroxine D) methimazole

Ans: C

Feedback: Levothyroxine is the drug of choice in children because of its predictable bioavailability and reliability. Liothyronine and liotrix tend to have more adverse effects and, although they can be used in children, are not the drugs of choice. Methimazole is an antithyroid drug and is used to treat hyperthyroidism.

Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 627, Clinically Important Drug–Drug Interactions 3. A client has a history of atrial fibrillation and is taking an oral anticoagulant. The client has been newly diagnosed with hypothyroidism and placed on levothyroxine. What assessment should the nurse prioritize? A) monitoring the client’s electrolyte levels B) assessing for signs and symptoms of infection C) assessing the client’s level of consciousness D) monitoring the client for increased bruising

Ans: D

Feedback: The effectiveness of an oral anticoagulant is increased if it is used in combination with a thyroid hormone. This may lead to increased bleeding and the need to decrease the dosage of the oral anticoagulant. This combination of medications does not create a heightened risk for infection, changes in LOC, or electrolyte imbalances.

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Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 624, Thyroid and Parathyroid Agents, Older Adults, Box 37.1 4. The nurse is providing an older adult client teaching regarding the administration of levothyroxine. What is the nurse’s priority teaching point? A) “Take the medication after breakfast.” B) “Take the medication with a full glass of water.” C) “Remain in the upright position for 30 minutes after taking it.” D) “Take the medication before going to bed at night.”

Ans: B

Feedback: The client should be instructed to take the medication with a full glass of water to help prevent difficulty swallowing and esophageal atresia. The medication should be taken on an empty stomach before breakfast. There is no need to maintain an upright position. The medication should be taken as a single daily dose before breakfast each day to ensure consistent therapeutic levels.

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Page and Header: 630, Antithyroid Agents 5. A client is seen in the clinic and diagnosed with hyperthyroidism. Before administering the prescribed potassium iodide, the nurse reviews the client’s health record. What finding would cause the nurse to alter the plan of care? A) The client takes furosemide 30 g PO daily for hypertension. B) The client has recently adopted a low-fat, low-sodium diet. C) The client normally has a bowel movement every 2 to 3 days. D) The client takes digoxin 0.125 mg daily.

Ans: D

Feedback: Potassium iodide will cause the client to move from hyperthyroidism to hypothyroidism, thus altering the client’s metabolism. Digoxin has a small margin of safety that could be altered by a change in thyroid function. Use of a loop diuretic will not likely affect the client’s thyroid treatment. A low-fat, low-sodium diet and a bowel movement at least every 2 to 3 days are important for maintenance of a healthy lifestyle but would not alter the plan of care.

Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 2, 3 Page and Header: 638, Antihypercalcemic Agents, Calcitonins 6. A client who takes calcitonin salmon for the treatment of Paget’s disease calls the clinic and reports flushing of the face and hands and a rash. What is the nurse’s best response? A) “We expected this to happen. Just ignore it and try your best not to worry about it.” B) “You will need to see the doctor immediately. Come in as soon as possible.”

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C) “This is a common adverse effect of your medication. Let us know if it doesn’t resolve.” D) “This is a serious adverse effect. Stop taking the drug and see the doctor today.”

Ans: C

Feedback: The most common adverse effects seen with this drug include flushing of the face and hands, rash, nausea and vomiting, urinary frequency, and local inflammation at the site of injection. Many of these adverse effects lessen with time, the duration varying with each individual client. Although it is an expected adverse effect, the nurse needs to provide more teaching instead of simply telling the client to ignore it and to not worry. The client does not need to be seen, and this is not likely a serious adverse effect.

Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 636, Drugs in Focus: Parathyroid Agents, Table 37.4 7. The nurse is teaching the client with a new prescription for ibandronate how to take the medication. Which instruction provided by the nurse is correct? A) “Take 150 mg once a month on the same day of the month.” B) “Take 70 mg once a week on the same day of the week.” C) “Take 400 mg each day, at the same time each day.” D) “Take 3 mg twice daily with food.”

Ans: A

Feedback: Ibandronate can be taken daily, monthly, or every 3 months. Taking 150 mg orally once a month on the same day of the month would be correct. If given IV

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every 3 months, the dose is 3 mg, and if taken daily, the dose is 2.5 mg/d. All other options are incorrect.

Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 630, Antithyroid Agents, Iodine solutions 8. The nurse admits an older adult client in thyroid crisis for whom surgery is not an option. What antithyroid drug would the nurse expect will be ordered? A) methimazole B) radioactive iodine C) propylthiouracil D) potassium iodide

Ans: B

Feedback: If antithyroid agents are needed in the older adult client, sodium iodide I131 may be the drug of choice because it has fewer adverse effects than the other agents. The use of sodium iodide is reserved for those clients who are not candidates for surgery, women who cannot become pregnant, and older adult clients with such severe, complicating conditions that immediate thyroid destruction is needed. Radioactive iodine targets the thyroid cells and destroys them without many adverse effects. Methimazole and propylthiouracil are antithyroid drugs but have cardiovascular adverse effects that might be unacceptable in an older adult client who is not a candidate for surgery. Effects of potassium iodide are short-lived and may precipitate further thyroid enlargement and dysfunction so they would not be used in a client who is not a candidate for surgery because they would not provoke long-term effects.

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Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 638, Antihypercalcemic Agents, Bisphosphonates 9. The nurse is caring for a client who is diagnosed with osteoporosis and who has been prescribed alendronate. What assessment should the nurse prioritize when monitoring for adverse effects? A) monitoring the client’s liver enzyme levels B) assessing the client’s urine output for hematuria C) assessing the client for joint pain or reduced range of motion D) monitoring the client for signs of esophageal erosion

Ans: D

Feedback: Alendronate can cause serious esophageal erosion if the client does not comply with staying upright after administration. It does not normally cause hepatotoxicity, joint pain, or genitourinary bleeding.

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10. What assessment findings would the nurse expect to see in a client who has overdosed on levothyroxine? A) nervousness, tachycardia, tremors B) somnolence, bradycardia, paresthesia C) hyperglycemia, hypertension, edema D) central obesity, constipation, sodium loss

Ans: A

Feedback: More pronounced adverse effects of levothyroxine would be seen including tremors, headache, nervousness, palpitations, tachycardia, allergic skin reactions, diarrhea, nausea, and vomiting. Somnolence, bradycardia, and paresthesia would be more likely with insufficient drug intake, which would cause hypothyroidism and other symptoms. Hyperglycemia, edema, central obesity, constipation, or sodium loss would not be associated with excess thyroid hormone.

Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 630, Antithyroid Agents, Thioamides 11. After administering propylthiouracil (PTU), what effect would the nurse anticipate the drug will have in the client’s body? A) to destroy part of the thyroid gland B) to inhibit production of thyroid hormone in the thyroid gland C) to suppress the anterior pituitary gland’s secretion of thyroid-stimulating hormone (TSH) D) to suppress the hypothalamus’s production of thyrotropin-releasing hormone (TRH)

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Ans: B

Feedback: PTU is a thioamide that acts by lowering thyroid hormone levels by preventing the formation of thyroid hormone in the thyroid cells, which lowers the serum levels of thyroid hormone. They also partially inhibit the conversion of thyroxine to triiodothyronine at the cellular level. Iodine solutions oversaturate thyroid cells and top production of thyroid hormone. Radioactive iodine destroys part of the thyroid gland. PTU does not impact production or secretion of TSH or TRH.

Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 628, Nursing Considerations for Patients Receiving Thyroid Hormones, Intervention with Rationale 12. The nurse provides teaching regarding levothyroxine to a client diagnosed with Hashimoto’s disease. What statement made by the client does the nurse interpret to mean that the drug teaching had been understood? A) “I can take this medication at any time of day, as long as it’s with food.” B) “I should take this medication on an empty stomach in the morning.” C) “I may have to take this for several months, until by symptoms subside.” D) “If I feel nauseated, I may take this drug with an antacid.”

Ans: B

Feedback: Adults who require thyroid replacement therapy need to understand that this will be a lifelong need. An established routine of taking the tablet first thing in the morning may help the client comply with the drug regimen. The drug should be taken on

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an empty stomach with a full glass of water. Antacids would slow or prevent absorption of the hormone replacement, so the client should be corrected.

Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 625, The Thyroid Gland, Hyperthyroidism 13. A client is diagnosed with a simple goiter and asks the nurse what caused it. What is the nurse’s best response? A) A goiter is the result of too much thyroxine. B) A goiter is the result of a chloride deficiency. C) A goiter is the result of too much TSH. D) A goiter is the result of an iodine deficiency.

Ans: C

Feedback: Goiter (enlargement of the thyroid gland) is an effect of hyperthyroidism, which occurs when the thyroid is overstimulated by thyroid-stimulating hormone (TSH). This can happen if the thyroid gland does not produce sufficient thyroid hormones to turn off the hypothalamus and anterior pituitary. In the body’s attempt to produce the needed amount of thyroid hormone, the thyroid is continually stimulated by increasing levels of TSH. There is a deficiency of thyroxine. It is not related to chloride or iodine deficiencies.

Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 1, 5 Page and Header: 622, The Thyroid Gland 14. The client diagnosed with hypothyroidism takes levothyroxine daily and has triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) levels drawn in the laboratory to check appropriateness of prescribed dosage. What results would the nurse analyze as indicating the need for a higher dosage of medication? A) elevated TSH, elevated T3, and reduced T4 levels B) reduced TSH, elevated T3 and T4 levels C) elevated TSH, reduced T3 and T4 levels D) reduced TSH, T3, and T4 levels

Ans: C

Feedback: TSH levels would be elevated to stimulate increased thyroid hormone secretion, whereas T4 and T3 will be low, which indicates the need for a higher dosage of medication. If TSH level is low, it would indicate a reduction in dosage would be needed, particularly if T3 and T4 levels are elevated.

Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 630, Antithyroid Agents 15. A client presents at the clinic reporting weight loss of 12 lb (5.45 kg) over the past 3 months despite an increased appetite. The nurse knows which medication would most likely benefit the client if a diagnosis of hyperthyroidism is made?

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A) calcitriol B) alendronate C) levothyroxine D) methimazole

Ans: D

Feedback: Hyperthyroidism is manifested by increased metabolism and energy usage; methimazole is used to treat hyperthyroidism. Calcitriol is an antihypocalcemic agent, and alendronate is a bisphosphonate to treat hypercalcemia. Levothyroxine would exacerbate the client’s hyperthyroidism.

Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 634, The Parathyroid Glands, Hyperparathyroidism 16. What client will the nurse assess most closely for secondary hyperparathyroidism? A) the 12-year-old client with hypothyroidism B) the 68-year-old client with chronic renal failure C) the 35-year-old client with diabetes mellitus D) the 48-year-old client with hyperthyroidism

Ans: B

Feedback: Secondary hyperparathyroidism occurs most frequently in clients with chronic renal failure. Primary hyperparathyroidism occurs more often in women between 60 and 70 years of age. Although hyperparathyroidism can occur at any age, the client with diabetes or thyroid disorder would not be at higher risk for the disorder.

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Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 623, The Thyroid Gland, Hypothyroidism; 625, Table 37.1; 626, Table 37.2 17. What drug would the nurse appropriately administer to a client diagnosed with depression and presenting with cold intolerance, bradycardia, and fatigue? A) teriparatide B) methimazole C) propylthiouracil D) levothyroxine

Ans: D

Feedback: This client’s signs and symptoms are characteristic of hypothyroidism. Levothyroxine, a synthetic salt of thyroxine, is the most frequently used replacement hormone to treat hypothyroidism because of its predictable bioavailability and reliability. Propylthiouracil and methimazole would be used to treat hyperthyroidism; teriparatide is an antihypocalcemic agent.

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Objective: 3 Page and Header: 627, Thyroid Agents, Contraindications and Cautions 18. The nurse is caring for a client who has been diagnosed with hypothyroidism and has a history of myocardial infarction and heart failure. What thyroid replacement drug would the nurse question if ordered? A) liothyronine B) levothyroxine C) thyroid desiccated D) methimazole

Ans: A

Feedback: Liothyronine and liotrix have a greater incidence of cardiac adverse effects and are not recommended for use in clients with potential cardiac problems or clients who are prone to anxiety reactions. Levothyroxine would be the drug of choice, and thyroid desiccated would not be contraindicated. Methimazole is a treatment for hyperthyroidism and would not be appropriate for the client with hypothyroidism.

Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 1, 3 Page and Header: 631, Antithyroid Agents, Clinically Important Drug–Drug Interactions 19. The nurse is caring for a client who has been newly diagnosed with hypothyroidism. The client also takes theophylline to control asthma symptoms. What change may need to be made to the client’s theophylline dose? A) Decrease theophylline dosage immediately. B) Increase theophylline dosage immediately. C) Discontinue the client’s theophylline

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D) Decrease theophylline dose when normal thyroid function returns.

Ans: A

Feedback: Theophylline clearance is decreased in hypothyroid states. As a result, the client may require a decreased dose of the drug. As the client approaches normal thyroid function, the theophylline dose may need to be increased back to its regular level.

Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 624, Thyroid and Parathyroid Agents, Adults, Box 37.1 20. The client is 8 weeks pregnant and requires an antithyroid medication. The nurse identifies what drug as the drug of choice for this client? A) propylthiouracil B) radioactive iodine C) alendronate D) methimazole

Ans: A Feedback: If an antithyroid drug is essential during pregnancy, propylthiouracil (PTU) is the drug of choice because it is less likely to cross the placenta and cause problems for the fetus. Radioactive agents should not be used. Bisphosphonates should be used during pregnancy only if the benefit to the client clearly outweighs the potential risk to the fetus. Methimazole is an antithyroid medication but would not be the drug of choice for the pregnant woman due to the associated risks.

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Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 622, The Thyroid Gland, Structure and Function 21. The nurse reports a client’s elevated serum calcium level and the client asks what controls calcium levels in the body. What is the nurse’s best response? A) renin B) parathyroid hormone (PTH) C) thyroid-stimulating hormone (TSH) D) erythropoietin

Ans: B

Feedback: PTH is the most important regulator of serum calcium levels in the body. Renin controls blood pressure, erythropoietin stimulates production of red blood cells, and TSH stimulates thyroid hormone secretion.

Format: Multiple Selection Chapter: 37 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 632, The Parathyroid Glands, Structure and Function 22. The nurse is caring for a client who has been diagnosed with hyperparathyroidism and asks the nurse why parathyroid hormone (PTH) is important. The nurse explains that PTH performs what actions in the body? Select all that apply.

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A) stimulation of osteoclasts B) increased intestinal absorption of calcium C) stimulation of calcitriol production D) increased excretion of calcium from kidneys E) decreased retention of vitamin D

Ans: A, B, C

Feedback: PTH has many actions, including stimulation of osteoclasts or bone cells to release calcium from the bone, increased intestinal absorption of calcium, increased calcium reabsorption from the kidneys, and stimulation of cells in the kidney to produce calcitriol. PTH increases absorption of calcium from the kidney and increases retention of vitamin D.

Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 638, Antihypercalcemic Agents 23. The nurse is caring for a client who has been diagnosed with osteoporosis and has been prescribed zoledronic acid. What should the nurse teach the client about the administration of this medication? A) “You’ll be given this drug intravenously once every 2 years.” B) “I’ll teach you how to work the inhaler that you’ll be given.” C) “It’s important to stay sitting upright after taking this medication.” D) “You’ll be taught how to self-administer subcutaneous injections safely and effectively.”

Ans: A

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Feedback: Zoledronic acid is given as a single IV infusion once every 2 years. It is not given orally, so there is no need to sit upright as with bisphosphonates. It is not given subcutaneously or by inhaler.

Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 624, Thyroid and Parathyroid Agents, Children, Box 37.1 24. The nurse is caring for a pediatric client with a new onset of hypercalcemia. What condition would be most likely to cause this altered serum calcium level? A) radiation injury B) malignancy C) liver failure D) hypothyroidism

Ans: B

Feedback: Hypercalcemia is relatively rare in children, although it may be seen with certain malignancies. It would not result from a radiation injury, which would be more likely to affect the thyroid gland, and it would not be caused by liver failure or hypothyroidism.

Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 640, Antihypercalcemic Agents, Prototype Summary: Alendronate, Evaluation 25. The nurse is caring for a client who takes alendronate. What laboratory result best demonstrates successful treatment? A) serum iodine 515 nmol/L (65.3 µg/L) B) free thyroxine 22 mmol/L (1.7 ng/dL) C) serum calcium 2.45 mmol/L (9.8 mg/dL) D) thyrotropin 3.1 mIU/L (3.1 mIU/L)

Ans: C

Feedback: Alendronate and risedronate are commonly used drugs for osteoporosis and calcium lowering. All of the listed components are within their respective reference ranges, but calcium levels are the focus of this client’s treatment.

Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 633, The Parathyroid Glands, Control 26. In addition to calcium, what electrolyte affects parathyroid hormone (PTH) secretion? A) magnesium B) sodium C) potassium D) zinc

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Ans: A

Feedback: Another electrolyte—magnesium—also affects PTH secretion by mobilizing calcium and inhibiting the release of PTH when concentrations rise above or fall below normal. Sodium, potassium, and zinc do not affect PTH function.

Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 635, Antihypocalcemic Agents 27. The nurse administers teriparatide and evaluates the drug as effective in achieving desired effects when what is assessed? A) increase in serum calcium and phosphorous B) increase in serum calcium and decrease in serum phosphorous C) decrease in serum calcium and phosphorous D) decrease in serum calcium and increase in serum phosphorous

Ans: B

Feedback: With once-daily administration, teriparatide stimulates new bone formation, leading to an increase in skeletal mass. It increases serum calcium and decreases serum phosphorous.

Format: Multiple Responses Chapter: 37 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 5 Page and Header: 634, The Parathyroid Glands: Hyperparathyroidism 28. A client is being evaluated for possible Paget’s disease. What assessment questions asked by the nurse demonstrates an understanding of this condition? Select all that apply. A) “Do the headaches you have make you dizzy as well?” B) “Does any member of your family have similar symptoms?” C) “Can you describe the bone pain you are experiencing?” D) “Do you understand why x-rays of your spine and pelvis were ordered?” E) “Have you ever been diagnosed with a hearing loss?”

Ans: A, B, C, D, E

Feedback: Paget’s disease is a genetically linked disorder that results in overactive osteoclasts that are eventually replaced by enlarged and softened bony structures. Clients with this disease report deep bone pain, headaches, dizziness, and hearing loss and usually have cardiac failure and bone malformation often noted in the spine, pelvis, long bones, skull.

Format: Multiple responses Chapter: 37 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 1, 3, 5 Page and Header: 632, Nursing Considerations for Patients Receiving Antithyroid Agents; 624, Thyroid and Parathyroid Agents: Children, Box 37.1 29. A 12-year-old child has been placed on antithyroid therapy. After receiving the appropriate client education, what question asked by the nurse will be helpful in determining the child’s understanding of their condition and treatment? Select all that apply.

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A) “How do you feel about needing to have blood drawn regularly?” B) “What have you learned about the side effects of methimazole?” C) “Can you tell me what causes hyperthyroidism?” D) “What are some things you can do to avoid getting a cold this winter?” E) “Can you bring a record of your most recent weight to each follow-up visit?”

Ans: A, B, C, D, E

Feedback: Hyperthyroidism (overactive thyroid) occurs when the thyroid gland produces too much of the hormone thyroxine. When an antithyroid agent is needed to treat a child diagnosed with hyperthyroidism, methimazole is the drug of choice because it is less toxic to the liver. Methimazole is also associated with bone marrow suppression, so the client using this drug must have frequent blood tests to monitor for this effect. Ensuring the client understands side effects is important when a new medication is started. It is also important for the client to understand the cause of a chronic condition in order for the client to best promote self-care and avoid future complications. Preventing a cold will help the client maintain health as the client is at increased risk of becoming sick. Weight loss is a symptom of hyperthyroidism and a factor that requires regular monitoring.

Format: Multiple Responses Chapter: 37 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 1, 5 Page and Header: 634, Signs and Symptoms of Calcium Imbalance, Table 37.3 30. A client has been hospitalized with a calcium level of 12.5 mg/dL (3.12 mmol/L). Which intervention will the nurse implement? Select all that apply. A) assessment of intake and output every 4 hours B) check lower extremities for edema status every 4 hours

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C) implementation of fall precautions D) assisting client with selection of high-fiber foods E) neurological assessment every 4 hours

Ans: A, C, D, E

Feedback: Normal serum calcium level is 8 to 10 mg/dL (2 to 2.5 mmol/L) with some interlaboratory variation in the reference range, and hypercalcemia is defined as a serum calcium level greater than 10.5 mg/dL (>2.5 mmol/L). Signs and symptoms of hypercalcemia include polyuria and polydipsia, ataxia, constipation, and stupor. These characteristics make regular monitoring of intake and output and neurological assessment appropriate. Fall precautions are directed at preventing injury associated with ataxia while supporting a high-fiber diet will help minimize constipation. Extremity edema is associated with hypocalcemia and should be monitored. Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 636, Drugs in Focus: Parathyroid Agents, Table 37.4 31. The nurse will anticipate preparing medication education regarding abaloparatide for which client? A) a 50-year-old male client diagnosed with Paget’s disease reporting a bone pain B) a 72-year-old female client with a history of three osteoporosis-related fractures C) a 45-year-old client with a history of renal impairment diagnosed with metabolic bone disease D) a 60-year-old client with a history of hypocalcemia newly diagnosed with renal impairment

Ans: B

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Feedback: The antihypocalcemic agent abaloparatide is prescribed for the management of postmenopausal clients with osteoporosis at high risk for fractures. Calcitriol is prescribed for the management of hypocalcemia and metabolic bone disease in clients with renal impairment. Alendronate, an antihypercalcemic agent, is prescribed for treatment of Paget’s disease and osteoporosis in males. Bone pain is an expected finding in clients with Paget’s disease.

Format: Multiple Choice Chapter: 37 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 624, Thyroid and Parathyroid Agents: Adults 32. What information should the nurse provide a female client newly prescribed thyroid replacement therapy to assure effective treatment outcomes? A) “Take this medication immediately upon getting up each morning.” B) “Maintaining a normal weight is vital for you to manage this condition.” C) “The medication therapy will likely be discontinued in 12 to 18 months.” D) “The medication can be discontinued if you become pregnant.”

Ans: A

Feedback: An established routine of taking the tablet first thing in the morning may help the client adhere to the drug regimen. Adults who require thyroid replacement therapy need to understand this will typically be a lifelong replacement need. Thyroid replacement therapy is necessary during pregnancy for clients who have been maintained on this therapy regimen. While maintaining a normal weight is ideal, it is not a criterion for successful treatment of this condition.

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Test Generator Questions, Chapter 38, Agents to Control Blood Glucose Levels Format: Multiple Choice Chapter: 38 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 1, 5 Page and Header: 654, Intervention with Rationale 1. A client diagnosed with type 1 diabetes reports recurrent hypoglycemia late in the morning. After collecting the health history, what finding should the nurse suspect is most likely causing the late morning hypoglycemia? A) The client likes to nap shortly after eating lunch. B) The client goes to the gym each day before work. C) The client often eats an early lunch, between 11:00 and 11:30. D) The client eats oatmeal early in the morning for breakfast.

Ans: B

Feedback: Physical exercise changes insulin requirements and may result in a delayed hypoglycemic reaction. Napping after lunch may be a result, not a cause, of hypoglycemia. Similarly, preferring an early lunch may be the client’s response to hypoglycemia but not the cause of it. Eating oatmeal early in the morning would help stabilize blood sugars until later in the morning and would not likely cause hypoglycemia.

Format: Multiple Choice Chapter: 38 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 649, Table 38.1 2. The nurse suspects the client diagnosed with diabetes may be having a hypoglycemic reaction when what manifestation is assessed? A) unpredictable behaviors B) diaphoresis C) flushing of the face D) fruity breath

Ans: B

Feedback: Diaphoresis and cool clammy skin are signs of hypoglycemia. Fruity breath accompanies ketoacidosis. Flushing of the face is associated with hyperglycemia. The client’s level of consciousness often changes, but uncharacteristic or unpredictable behaviors do not normally occur.

Format: Multiple Choice Chapter: 38 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 5, 6 Page and Header: 665, Noninsulin Injectable Antidiabetics 3. The nurse is preparing education for a client who has been diagnosed with diabetes and is to begin taking pramlintide acetate as an adjunct to insulin therapy. What is the priority nursing instruction to include in this teaching plan? A) “Inject the drug immediately before you eat a major meal.” B) “The drug’s effects take place quickly after it’s administered.” C) “Inject the drug at least 2 in away from any insulin injection site.”

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D) “Remember that diabetes is fundamentally a problem with glucose metabolism.”

Ans: A

Feedback: Pramlintide works to modulate gastric emptying after a meal, so correct timing of administration of this drug is essential to its function. It is true that the drug has a rapid onset and peak, but the correct timing and route for administration are priority teaching points. Similarly, timing and route would be prioritized over maintaining a particular distance from insulin injections sites, even though this guideline is correct. Statements about the pathophysiology of diabetes would not be a high priority.

Ans: D Feedback: Glulisine has an onset of 2 to 5 minutes and peaks in 30 to 90 minutes, so it has the fastest onset of action. Lispro has an onset in <15 minutes and also peaks at 30 to 90 minutes. Aspart takes 10 to 20 minutes for onset and peeks in 1 to 3 hours. Regular insulin has a 30- to 60-minute onset and peaks in 2 to 4 hours.

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Format: Multiple Choice Chapter: 38 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 646, Diabetes Mellitus 5. The client, newly diagnosed with diabetic retinopathy, asks what caused this disorder. What is the nurse’s best response? A) inability of cells in the eye to reproduce B) increase of aqueous humor in the eye C) loss of innervation throughout the eye D) inability of oxygen to diffuse to tissues in the eye

Ans: D

Feedback: The body’s inability to effectively cope with carbohydrate, fat, and protein metabolism over a long period of time results in a thickening of the basement membrane in large and small blood vessels. This thickening leads to changes in oxygenation of the lining of the vessels causing damage and narrowing of the vessels. The decreased blood flow through the vessels results in the inability of oxygen to rapidly diffuse across the membrane to the tissues of the eye. The tiny vessels of the eye are narrowed and closed, which causes loss of vision. Increase of aqueous humor is seen in glaucoma. Inability of cell replication and decrease in nerve innervations throughout the eye is not associated with retinopathy.

Format: Multiple Choice Chapter: 38 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 646, Diabetes Mellitus 6. A client in the community is taking regular and NPH insulin to manage type 1 diabetes. What laboratory finding best demonstrates that the client’s diabetes management is adequate? A) The client’s random blood glucose is 120 mg/dL (6.7 mmol/L). B) The client’s creatinine clearance of 1.75 mL/s/m2 is within reference ranges. C) The client’s glycosylated hemoglobin (HbA1c) level is 6.1% (0.06). D) The client’s fasting blood glucose level is 80 mg/dL (4.4 mmol/L).

Ans: C

Feedback: HbA1c levels provide a 3-month average of glucose levels, which provides the best evaluation tool to measure the overall client response to the treatment plan. A value of 7% or lower is deemed adequate. Fasting and random blood glucose levels provide one-time points of data but cannot be extrapolated to determine the client’s overall response to therapy. The absence of diabetic nephropathy does not necessarily show that the client’s management program is meeting their needs.

Format: Multiple Choice Chapter: 38 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 2, 4, 5 Page and Header: 669, Drugs in Focus: Glucose-Elevating Agents, Table 38.4 7. A client is brought to the emergency department with hypoglycemia blood glucose level of 19 mg/dL. What drug should the nurse prepare to administer intravenously? A) diazole oral

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B) glyburide oral C) glucagon intravenous injection D) insulin subcutaneous injection

Ans: C

Feedback: This client will need a glucose-elevating agent. Glucagon is given parenterally only and is the preferred agent for emergency situations. Diazole is also a glucose-elevating agent but is only administered orally, so it would take longer to take effect. Insulin would be administered for hyperglycemia. Glyburide is an oral antidiabetic agent, which is a second-generation sulfonylurea and is administered for hyperglycemia.

Format: Multiple Choice Chapter: 38 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 653, Insulin: Clinically Important Drug–Drug Interactions 8. The nurse should question what medication order for a client diagnosed with diabetes and who is currently taking insulin? A) propranolol 10 mg orally t.i.d. B) furosemide 60 mg/d orally C) cefaclor 250 mg orally every 8 hours D) metoclopramide 20 mg PO

Ans: A

Feedback: Propranolol is a beta-blocker and should be avoided in combination with insulin. The blocking of the sympathetic nervous system also blocks many of the signs and symptoms of hypoglycemia, hindering the client’s ability to recognize problems. If

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propranolol must be taken, the nurse will need to teach this client other ways to recognize hypoglycemia. Furosemide, cefaclor, and metoclopramide do not cause drug– drug interactions with insulin.

Format: Multiple Choice Chapter: 38 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 653, Prototype Summary: Insulin 9. A client diagnosed with type 1 diabetes presents to the diabetes educator and asks about a change in insulin. The client’s occupation requires long international flights, and the client does not want to administer insulin on the plane. What kind of insulin would best meet this client’s needs? A) lispro B) glulisine C) glargine D) aspart

Ans: C

Feedback: Glargine has a duration of 24 hours, which may prevent the client from having to administer insulin on the airplane. Lispro has a duration of 2 to 5 hours and a peak time of 30 to 90 minutes. Glulisine has a duration of 1 to 2.5 hours and a peak time of 30 to 90 minutes. Aspart has a duration of 3 to 5 hours and a peak time of 1 to 3 hours. These would likely require administration on the plane.

Format: Multiple Choice Chapter: 38

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Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 648, Insulin 10. The diabetes nurse educator describes type 1 diabetes with what statement? A) Blood glucose level can be controlled with diet. B) Exogenous insulin is required for life. C) Oral agents can control blood glucose levels for many clients. D) It is always diagnosed before adulthood.

Ans: B

Feedback: Type 1 diabetes is a disorder that destroys pancreatic beta cells. Insulin is the only effective treatment for type 1 diabetes because pancreatic beta cells are unable to secrete endogenous insulin, and metabolism is severely impaired. In type 1 diabetes, blood glucose levels cannot be controlled with diet, oral agents cannot control the disease process because they stimulate insulin production, and the client with type 1 diabetes does not produce insulin. It can be diagnosed at other stages of the lifespan than just in early childhood.

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11. A client is admitted to the emergency department in diabetic ketoacidosis (DKA) with a blood glucose level of 485 mg/dL (26.9 mmol/L). The client is prescribed an initial dose of 25 U insulin IV. Which type of insulin will be most likely to be administered? A) NPH insulin B) Humulin L insulin C) Humulin N insulin D) regular insulin

Ans: D

Feedback: Regular insulin is a short-acting insulin that manages the hyperglycemia and hyperkalemia resulting from DKA, which is a life-threatening complication that occurs with severe insulin deficiency. Furthermore, only regular insulin can be given IV and is the drug of choice in emergency situations. Humulin N, Humulin L, and NPH are intermediate-acting forms.

Format: Multiple Choice Chapter: 38 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 2, 4, 6 Page and Header: 663, Meglitinides 12. What instructions should the nurse give to a client who has been diagnosed with type 2 diabetes and has been switched from glyburide to repaglinide? A) “It is less potent, so you’ll likely be prescribed a larger dose.” B) “Repaglinide rapidly stimulates insulin production, so you need to eat soon after taking the medication.” C) “It has a greater effect and is longer lasting, so you’ll be prescribed it every other day.”

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D) “The two medications are fundamentally similar, but some clients respond better to one than the other.”

Ans: B

Feedback: Glyburide is a second-generation sulfonylurea that stimulates insulin release from the beta cells in the pancreas with a 2- to 4-hour onset of action. Repaglinide has an onset of action within 30 minutes with peak effect in 1 hour, and duration of action is approximately 3 to 4 hours. Because repaglinide has a much faster onset of action, it is important that the client eats within 15 to 30 minutes after taking the drug to avoid hypoglycemia. Repaglinide is not less potent, it is not more potent, and the two medications are not virtually the same.

Format: Multiple Choice Chapter: 38 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 5, 6 Page and Header: 654, Insulin: Intervention with Rationale 13. The nurse is instructing a client how to mix NPH insulin with regular insulin in one syringe. The nurse tells the client that the mixture must be administered within how long after it is prepared? A) 5 minutes B) 10 minutes C) 15 minutes D) 20 minutes

Ans: C

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Feedback: Use caution when mixing types of insulin. Administer mixtures of regular and NPH insulins within 15 minutes after combining them to ensure appropriate suspension and therapeutic effect.

Format: Multiple Selection Chapter: 38 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 650, Antidiabetic Agents: Children, Box 38.4 14. The nurse is caring for a 3-year-old child who has been newly diagnosed with type 1 diabetes. When developing the plan of care for this child, the nurse should incorporate what characteristics of pediatric clients into the plan? Select all that apply. A) Children have a faster metabolic rate than adults. B) Growth and development considerations have a high priority. C) Insulin doses may be so small that they are difficult to calibrate accurately. D) It can be challenging to implement dietary modifications are acceptable to the client. E) The physiology of glucose metabolism differs in children compared with adults.

Ans: A, B, C, D

Feedback: Treatment of diabetes in children is a difficult challenge of balancing diet, activity, growth, stressors, and insulin requirements. Children need to be carefully monitored for any sign of hypoglycemia or hyperglycemia and treated quickly because their fast metabolism and lack of body reserves can push them into a severe state quickly. Insulin dosage, especially in infants, may be so small that it is difficult to calibrate. Insulin often needs to be diluted to a volume that can be detected on the syringe. Dietary modifications can be difficult to implement in children and adolescents. The physiology of glucose metabolism does not fundamentally differ in children.

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Format: Multiple Choice Chapter: 38 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 649, Drugs in Focus: Insulin, Table 38.2 15. With what client should the nurse question the administration of human insulin? A) a client who has been diagnosed with gestational diabetes B) a client with type 2 diabetes, controlled with oral antidiabetic agents, who has a systemic infection C) a client who has been living with type 1 diabetes for 20 years D) a client whose type 2 diabetes is controlled by diet and exercise

Ans: D

Feedback: Insulin is recommended for treatment of type 2 diabetes in clients whose diabetes cannot be controlled by diet or other pharmacotherapeutic agents. If the diabetes can be controlled by diet, the pancreas is still functioning and releasing insulin. Human insulin can be used in clients with gestational diabetes or clients with type 1 diabetes of many years standing. The presence of an infection may require the use of insulin in a client whose diabetes is normally controlled by oral medications.

Format: Multiple Selection Chapter: 38 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5, 6

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Page and Header: 651, Insulin Delivery: Past, Present, and Future: Present, Box 38.5 16. The nurse is teaching a client who has been diagnosed with type 2 diabetes about the newly prescribed external insulin pump. What are appropriate teaching points for the nurse to include? Select all that apply. A) “Watch for signs and symptoms of infection.” B) “Check your blood glucose frequently.” C) “Change the tubing frequently, at recommended intervals.” D) “Make sure to have your pump calibrated weekly.” E) “Additional insulin requires a separate injection site.”

Ans: A, B, C Feedback: This pump device can be worn on a belt or hidden in a pocket and is attached to a small tube inserted into the subcutaneous tissue of the abdomen. The device slowly leaks a base rate of insulin into the abdomen all day; the client can pump or inject additional booster doses throughout the day to correspond with meals and activity. However, the tubing poses an increased risk of infection and requires frequent changing, and the client has to frequently check blood glucose levels throughout the day to monitor response. There is no need to calibrate the pump.

Format: Multiple Choice Chapter: 38 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 648, Focus on the Evidence: Managing Glucose Levels During Stress: Stress Reactions 17. The nurse in the emergency department receives a conscious client following a motor vehicle accident who has no known history of diabetes but whose blood glucose level is 325 mg/dL (18 mmol/L). What rationale does the nurse provide explaining this elevated blood glucose level?

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A) The client’s accident was caused by undiagnosed hyperglycemia. B) The client may have sustained pancreatic trauma. C) The client most likely ate a meal just before the accident. D) The client’s stress reaction likely caused an increase in blood sugar.

Ans: D

Feedback: The stress reaction elevates the blood glucose concentration above the normal range. In severe stress situations, the blood glucose level can be very high (300 to 400 mg/dL/16.7 to 22 mmol/L). The body uses that energy to fight the insult or flee from the stressor. It would be unlikely for a hyperglycemic episode to cause a change in consciousness that would result in an accident. Eating food does not cause such a large increase in glucose levels. Pancreatic trauma does not normally cause a precipitous increase in blood glucose levels.

Format: Multiple Choice Chapter: 38 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 6 Page and Header: 653, Focus on Herbal and Alternative Therapies: Box 38.8 18. A client diagnosed with type 2 diabetes presents to the clinic for a routine follow-up appointment. The client asks the nurse, “Can I take ginseng?” What is the correct response by the nurse? A) “It increases the risk for high blood glucose levels.” B) “It increases the risk for low blood glucose levels.” C) “There is no research to indicate what effect it will have.” D) “There is no reason ginseng cannot be taken by people with diabetes.”

Ans: B

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Feedback: Clients being treated with antidiabetic therapies are at an increased risk of developing hypoglycemia if they use herbals containing juniper berries, ginseng, garlic, fenugreek, coriander, dandelion root, or celery. If a client uses these therapies, blood glucose levels should be monitored closely and appropriate dose adjustment made in the prescribed drug.

Format: Multiple Choice Chapter: 38 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 659, Sulfonylureas 19. The nurse is caring for a client who has been prescribed tolbutamide several years ago. The prescription has now been changed to glimepiride. When asked by the client why the prescription was changed, what is the nurse’s response? A) “There are safer options available now.” B) “Glimepiride is cheaper than tolbutamide.” C) “The effectiveness of tolbutamide wanes after several years of therapy.” D) “Glimepiride will prevent the development of hypoglycemia.”

Ans: A

Feedback: The use of first-generation sulfonylureas has declined as safer drugs have become available. The second-generation drugs include glimepiride, glipizide, and glyburide. Cost is not a factor in the prescription of medication. Tolbutamide is not known to cause tolerance issues. Glimepiride will decrease the risk of hypoglycemia but not eliminate it entirely.

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Format: Multiple Choice Chapter: 38 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 4, 6 Page and Header: 653, Prototype Summary: Insulin 20. A client diagnosed with type 1 diabetes has been prescribed 12 units of regular insulin and 34 units of NPH insulin in the morning. How should the nurse explain why two different types of insulin are required to control the client’s blood glucose? A) “The different onsets and peaks of the two types provide better overall glucose control.” B) “NPH prevents regular insulin from being broken down in the body, allowing the use of a lower dose.” C) “The combination negates the risk of adverse effects that would likely accompany a single, larger dose.” D) “NPH stimulate the pancreas to produce more insulin, while regular insulin provides your body’s short-term needs.”

Ans: A

Feedback: Regular insulin will begin working within 30 to 60 minutes and peak within 2 to 4 hours and a 6- to 12-hour duration of action, whereas NPH insulin has an onset of 60 to 90 minutes and peaks in 4 to 12 hours, with a 24-hour duration of action. By giving both drugs at once, the client gets rapid blood glucose control within 30 minutes from the regular insulin, and the control lasts 24 hours due to NPH’s long duration of action. NPH has no effect on the breakdown of regular insulin, and there is not necessarily a reduced risk of adverse effects. NPH does not stimulate the pancreas toward increased insulin production.

Format: Multiple Choice

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Chapter: 38 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 662, Biguanide: Prototype Summary: Metformin 21. What antidiabetic agent is approved for the nurse to administer to clients 10-yearsold and older with type 2 diabetes? A) pioglitazone B) repaglinide C) liraglutide D) metformin

Ans: D

Feedback: Metformin is the only oral antidiabetic drug approved for children. It has established dosage for children 10 years of age and older. With the increasing number of children being diagnosed with type 2 diabetes, the use of other agents in children is being tested. Because metformin is the only drug approved for use with children, pioglitazone, repaglinide, and liraglutide would not be appropriate.

Format: Multiple Choice Chapter: 38 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 660, Sulfonylureas: Contraindications and Cautions 22. The nurse is caring for a client who has been diagnosed with pregnancy-induced diabetes. What antidiabetic agent is best suited for administration to this client?

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A) metformin B) acarbose C) insulin D) glyburide

Ans: C

Feedback: Insulin therapy is the best choice for clients with diabetes during pregnancy and lactation, which are times of high stress and metabolic demands. Oral antidiabetic medications are contraindicated during pregnancy, so metformin, acarbose, and glyburide are not the best choices.

Format: Multiple Choice Chapter: 38 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 650, Antidiabetic Agents: Older Adults, Box 38.4 23. The home care nurse is caring for an older adult client who has been diagnosed with type 1 diabetes. The client has visual impairment and cannot read the numbers on the syringe when preparing insulin for administration nor afford the cost of prefilled auto syringes. What strategy might the nurse use to help this client comply with insulin needs between visits? A) Change the client to oral antidiabetics. B) Prepare a week’s supply of syringes and refrigerate. C) Have the client use a magnifying glass. D) Ask a neighbor to come over every day to prepare the medication.

Ans: B

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Feedback: Older adults can have many underlying problems that complicate diabetic therapy. Poor vision and/or coordination may make it difficult to prepare a syringe. A week’s supply of syringes can be prepared and refrigerated for the usual dose of insulin. If the client is using insulin, it is most likely because oral antidiabetic medications don’t work. A magnifying glass is impractical because drawing up medication requires two hands and a magnifying glass will not help the client to see well enough to be safe. It is a big imposition to expect a neighbor to be constantly available, and this would not be the best choice.

Format: Multiple Selection Chapter: 38 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 647, Diabetes Mellitus: Hyperglycemia 24. The nurse admits a client to the emergency department and recognizes that the client is in diabetic ketoacidosis (DKA) when what manifestations are assessed? Select all that apply. A) fruity breath B) edema C) dehydration D) agitation E) slow and deep respirations

Ans: A, C, E

Feedback: Signs of impending dangerous complications of hyperglycemia such as DKA include the following: fruity breath as the ketones build up in the system and are excreted through the lungs; dehydration as fluid and important electrolytes are lost through the kidneys; slow and deep respirations (Kussmaul respirations) as the body

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tries to rid itself of high acid levels; loss of orientation and coma rather than agitation are to be expected. Edema is not a sign of DKA.

Format: Multiple Choice Chapter: 38 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 6 Page and Header: 651, Insulin: Contraindications and Cautions 25. The nurse is caring for a pregnant client who has been diagnosed with gestational diabetes and is being treated with insulin. The client has expressed her intention to breastfeed her infant. What should the nurse teach the client? A) “That won’t be a problem, because you won’t need any more insulin after you give birth.” B) “It’s safe to keep taking insulin while breastfeeding, but it might affect your milk supply somewhat.” C) “Have you spoken with your care provider to discuss alternatives for feeding your baby?” D) “Unfortunately, taking insulin while breastfeeding creates a serious risk for low blood sugar in your infant.”

Ans: B

Feedback: Insulin enters breast milk, but it is destroyed in the GI tract and does not affect the nursing infant. However, insulin-dependent clients may have inhibited milk production because of insulin’s effects on fat and protein metabolism. The client will not experience an instant resolution of gestational diabetes at the time of delivery; further insulin may be needed.

Format: Multiple Choice

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Chapter: 38 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 670, Glucose-Elevating Agents: Intervention with Rationale 26. What outcome would best indicate that the nurse’s teaching of a client who has been newly diagnosed with diabetes was effective and that drug therapy is appropriate? A) The client can explain how to take the medication. B) The client demonstrates the correct procedure for monitoring blood sugar. C) The client follows an appropriate diet. D) Blood glucose level is stable with no diabetic complications.

Ans: D

Feedback: The single best indicator, and the goal of treatment, is to help the client maintain a stable blood glucose level so as to be able to avoid any complications. For the client to maintain a stable blood glucose level, they needs to understand how to take the medication, to check the blood sugar level, and to follow an appropriate diet, but the best indicator is the stable glucose level.

Format: Multiple Choice Chapter: 38 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 653, Insulin: Pharmacokinetics 27. The nurse is caring for a postoperative client whose diabetes has been well controlled on acarbose. The client is not allowed to take anything orally following

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complications of abdominal surgery and is receiving high-glucose total parenteral nutrition via a central IV line. What medication can the nurse administer intravenously to control the client’s blood glucose level? A) glyburide B) acarbose C) NPH insulin D) regular insulin

Ans: D

Feedback: Only regular insulin can be administered IV. No other insulins or oral antidiabetic medications can be given IV.

Format: Multiple Choice Chapter: 38 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 661, Biguanide 28. The nurse is caring for a client who has been diagnosed with polycystic ovary syndrome. What antidiabetic drug would the nurse anticipate will be ordered? A) metformin B) acarbose C) insulin D) glyburide

Ans: A

Feedback: Metformin and pioglitazone have proven effective in increasing insulin sensitivity and decreasing androgen and luteinizing hormone levels to break the cycle

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and allow ovulation to occur if pregnancy is desired. A fertility drug is often used with the antidiabetic agent. Other options are not appropriate because they are not indicated for treating polycystic ovary syndrome.

Format: Multiple Choice Chapter: 38 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 664, Sodium-Glucose Cotransporter-2 Inhibitors (SGLT-2 Inhibitors): Prototype Summary: Canagliflozin 29. The nurse is caring for a client who is taking canagliflozin. What is an advantage of this medication? A) reduces risk of heart attack or stroke B) has no adverse effects C) is taken four times a day D) long-term studies needed

Ans: A

Feedback: Some SGLT-2 inhibitors like canagliflozin have been found to decrease risk of cardiovascular death and hospitalization due to heart failure in adults with and without type 2 diabetes and/or heart failure and to slow the progression of renal disease in clients with chronic kidney disease. All drugs have adverse effects. Taking the medication four times a day and the need for long-term studies are not advantages of the drug.

Format: Multiple Choice Chapter: 38 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 657, Drugs in Focus: Oral Antidiabetic Agents and Noninsulin Injectable Antidiabetic Agents: Table 38.3 30. The nurse transcribes an order for sitagliptin. What is an appropriate dosage range for this medication? A) 0.25 to 3 g/d B) 1 to 8 mg/d C) 100 mg/d D) 5 mg orally daily

Ans: C

Feedback: The appropriate dosage range for oral sitagliptin is 100 mg/d. Tolbutamide is 0.25 to 3 g/d. Glimepiride is 1 to 8 mg/d. Glipizide is taken 5 mg PO daily.

Format: Multiple Choice Chapter: 38 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 6 Page and Header: 647, Focus on Diagnosis of Diabetes Mellitus: Box 38.2 31. The nurse is caring for a client who has been newly diagnosed with diabetes mellitus. Which statements made by the client suggests to the nurse a clear understanding of the criteria used to diagnosis the condition? A) “My fasting plasma glucose was 120 mg/dL (6.7 mmol/L) after fasting for 6 hours.” B) “When the result of my hemoglobin A1C (HbA1c) test came back, it was 7.2% (0.07)” C) “The result of my oral glucose tolerance test was 240 mg/dL (13.32 mmol/L).”

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D) “When I was demonstrating symptoms of hyperglycemia, the result of a random plasma glucose test was 180 mg/dL (10 mmol/L).”

Ans: B

Feedback: The criteria for the diagnosis of diabetes requires meeting one of the following criteria: fasting (no caloric intake for at least 8 hours) plasma glucose ≥126 mg/dL (6.99 mmol/L), 2-hour plasma glucose ≥200 mg/dL (11.1 mmol/L) during oral glucose tolerance test, HbA1c ≥6.5% (0.07), in a client with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1 mmol/L). A HbA1c of 7.2% (0.07) would meet the stated criteria.

Format: Multiple Choice Chapter: 38 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 1, 6 Page and Header: 648, Managing Glucose Levels During Stress: Box 38.3 32. A 16-year-old client who is unconscious has been brought to the emergency room by an ambulance after sustaining multiple injuries in a motorcycle accident. The client’s parents arrived shortly after admission and provided consent for necessary treatment including surgery. Preoperative lab work results indicate a blood glucose concentration of 380 mg/dL (21.09 mmol/L). What initial intervention should the nurse be prepared to implement to best manage the client’s blood glucose status? A) Administer prescribed intravenous (IV) insulin. B) Monitor the client’s glucose level every hour. C) Ask the parents to calmly talk to the client in order to reduce stress. D) Confirm with the parents whether the client has a history of diabetes.

Ans: D

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Feedback: The stress reaction elevates blood glucose concentration above the normal range. In severe stress situations, the blood glucose level can be high (200 to 300 mg/dL [11.1 to 16.7 mmol/L]). The nurse’s initial action is to determine from the parents whether the client has been diagnosed with diabetes. The usual medical response to a blood glucose concentration of 400 mg/dL (22.2 mmol/L) is the administration of insulin especially if the client’s health history is unknown. Clients with diabetes who are in severe stress situations require changes in insulin doses but should be allowed some elevation of blood glucose, even though the inability to produce sufficient insulin will make it difficult for cells to make effective use of the increased glucose level. Relieving the stress reaction can also drop glucose levels as the stimulus to increase these levels is lost and the glucose that was there is used for energy. While all the options are appropriate in some situations, it is best to first identify whether the client has a history of diabetes in order to determine the best option.

Format: Multiple Choice Chapter: 38 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 650, Antidiabetic Agents: Children, Box 38.4 33. A 6-month-old client is prescribed insulin therapy while in the neonatal intensive care unit (NICU). The client is crying and vigorously flailing about in the crib. What action should the nurse take to best assure safe, accurate delivery of the medication? A) Dilute the insulin to a volume that can be safely identified on the syringe. B) Check the calculation and dose with another registered nurse (RN). C) Use an insulin pump to deliver the prescribed medication dose. D) Have a nurse hold the client’s extremities while administering the medication.

Ans: B

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Feedback: The primary concern is accuracy of the insulin dosage. Insulin dose, especially in infants, may be so small that it is difficult to calibrate. Insulin often needs to be diluted to a volume that can be detected on the syringe. Regardless of the route and/or delivery method, it is most important that a second registered nurse (RN) always check the calculations and dose of insulin being given to small children. While stabilizing the infant’s extremities is appropriate, the critical intervention still focuses on accurate dosage of the insulin.

Test Generator Questions, Chapter 39, Introduction to the Reproductive System Format: Multiple Choice Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 675, Introduction 1. A client’s sex glands have responded to stimulation from follicle-stimulating hormone (FSH) and luteinizing hormone (LH). What endocrine activity has directly preceded the release of FSH and LH? A) Chemoreceptors detected a deficiency in growth hormone–releasing hormone (GHRH). B) The client’s hypothalamus detected a deficiency in both hormones and released them. C) The client’s anterior pituitary gland was stimulated by gonadotropin-releasing hormone (GnRH). D) The client’s hypothalamus responded to stimulation from prolactin-releasing hormone (PRH).

Ans: C

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Feedback: The male and female glands respond to luteinizing hormone (LH) and FSH, which are released from the anterior pituitary in response to stimulation from GnRH that is released from the hypothalamus. GHRH stimulates the release of the growth hormone, which targets cell growth; this hormone is uninvolved in FSH and LH synthesis or release. LH and FSH are released by the anterior pituitary, not the hypothalamus. PRH does not act on the hypothalamus, which initiates its synthesis. Format: Multiple Choice Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 676, Structures 2. A nurse is providing health education to a female client in a fertility clinic. The nurse explains possible reasons for infertility. When explaining how the ovaries are involved in conception, what will the nurse stress? A) Ova quickly degenerate, and most are absorbed in the body before the age of 12. B) The ovaries at birth contain all of the ova that a woman will have. C) Ova aggregate, causing millions to be contained in a storage site called a follicle. D) Follicles produce only estrogen; the uterus produces progesterone.

Ans: B

Feedback: It would be important to explain that the client’s ova do not increase or decrease from birth to childbearing years. The nurse will stress that all the ova that a client will have will be present at birth. The client should understand that if the client does not ovulate 1 month or for several months, it is not because the client has done something to her body to cause this. Ova slowly degenerate over a lifetime, or they are released once a month until menopause is complete. Each ovum is contained in a storage site called a follicle, which produces the female sex hormones, estrogen and progesterone.

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Format: Multiple Choice Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 4 Page and Header: 676, Female Reproductive System: Hormones 3. The nurse is assessing a client who has recently become pregnant. What hormone activity is most likely to maintain the pregnancy until birth of the fetus? A) high levels of estrogen for the first trimester, gradually declining throughout pregnancy B) temporary cessation of gonadotropin-releasing hormone (GnRH) C) high levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) D) high levels of estrogen and progesterone throughout pregnancy

Ans: D

Feedback: In a pregnant woman, both estrogen and progesterone hormones have specific functions. High levels of both hormones are needed for the maintenance of pregnancy. Pregnancy is not maintained through the actions of GnRH, FSH, or LH.

Format: Multiple Choice Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 677, Effects of Progesterone: Box 39.2

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4. Diagnostic testing has revealed a deficiency in a client’s progesterone levels. What assessment finding is most likely to be the result of this change in endocrine function? A) oral temperature 96.3°F (35.7°C) B) increased appetite C) blood glucose 60 mg/dL (3.3 mmol/L) D) facial flushing

Ans: C

Feedback: Progesterone has an anti-insulin effect to generate a higher blood glucose concentration to allow for rapid diffusion of glucose to the developing embryo. Conversely, low progesterone would correlate with hypoglycemia, which this client is experiencing. Body temperature and appetite are increased by progesterone. This client’s temperature would be considered to be in the low-normal range and would not be considered to be exceptionally low. Facial flushing would not accompany low progesterone levels.

Format: Multiple Choice Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 2 Page and Header: 677, Female Reproductive System: Control Mechanisms 5. What hormone causes ovulation to occur? A) adrenocorticotropic hormone (ACTH) B) luteinizing hormone (LH) C) prolactin D) follicle-stimulating hormone (FSH)

Ans: B

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Feedback: When the circulating estrogen level rises high enough, it stimulates a massive release of LH from the anterior pituitary causing one of the developing follicles to burst and release the ovum with its stored hormones into the system. ACTH targets the adrenal corticosteroid hormone, which helps prepare the body for the “fight-or-flight” response. Prolactin is responsible for milk production, and FSH in combination with LH stimulates follicles on the outer surface of the uterus to grow and develop and also stimulates the release of estrogen and progesterone.

Format: Multiple Choice Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 678, Female Reproductive System: The Menstrual Cycle 6. A 16-year-old female client presents to the clinic reporting severe menstrual cramps. The client is concerned about the pain and worried that “something is wrong.” The nurse explains to the client cramping during a menstrual period is because of what? A) an increase in the levels of estrogen and progesterone, which cause uterine contractions B) low levels of plasminogen in the uterus that cause the shedding of the lining of the uterus C) prostaglandins in the uterus, which stimulate uterine contractions, clamp off vessels as the lining of the uterus sheds D) an increase in progesterone and a decrease of estrogen causing the lining of the uterus to slough away

Ans: C

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Feedback: Prostaglandins in the uterus stimulate uterine contractions to clamp off vessels in the lining of the uterus, which is the cause of the cramping. The decrease of estrogen and progesterone after the involution of the corpus luteum triggers the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The decreased levels of FSH and LH cause the inner lining of the uterus to slough off because the vascular system is no longer being stimulated. High, not low, levels of plasminogen in the uterus prevent clotting of the lining as the vessels shear off.

Format: Multiple Choice Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 677, Female Reproductive System: Control Mechanisms 7. What hormone is the first to be produced when the ovum is fertilized and implanted in the uterine wall? A) growth hormone (GH) B) human chorionic gonadotropin C) prolactin D) adrenocorticotropic hormone (ACTH)

Ans: B

Feedback: After the ovum is fertilized and implants itself in the uterine wall, human chorionic gonadotropin is produced by the junction of the fertilized embryo with the uterine wall. ACTH and GH are not involved with this process. The release of prolactin helps with milk production for the delivered fetus.

Format: Multiple Choice

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Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 682, Effects of Testosterone: Box 39.3 8. The nurse is assessing a male client who is beginning puberty. What phenomenon should the nurse attribute to the client’s increasing testosterone levels? A) increased hematocrit B) increased leukocyte levels C) thinning of the cartilage and skin D) increased insulin secretion

Ans: A

Feedback: Testosterone causes hematocrit to increase and causes thickening of skin and cartilage, which affects the male gait. It is not responsible for changes in leukocyte levels or insulin levels.

Format: Multiple Choice Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 682, The Human Sexual Response 9. A nurse is teaching a sex education course in a local high school. What statement, made by the nurse, would be accurate regarding the human sexual response? A) Humans require endocrine stimuli during a time period called estrus for a sexual response to occur.

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B) Stimulation occurs with large increases in sensitivity. C) Sexual climax occurs from massive sympathetic stimulation. D) The period of recovery is initiated with parasympathetic stimulation.

Ans: C

Feedback: Stimulation in humans occurs with mild increases of sensitivity and the climax occurs from massive sympathetic stimulation. Many animals require an estrous cycle to become stimulated but that is not true of humans. The period of recovery occurs when the sympathetic stimulation is resolved.

Format: Multiple Choice Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 680, Male Reproductive System: Hormones 10. The nurse is caring for an older adult client following bilateral castration as part of testicular cancer treatment. The client asks the nurse what physical changes they can expect because of this surgery. The nurse explains the client can expect which effects? A) Maintain normal male characteristics. B) Develop a wider and flatter pelvis. C) Gradually lose facial hair. D) Take on some female characteristics.

Ans: A

Feedback: Increased testosterone levels in boys at puberty results in thickening of the skin, a deeper voice, development of facial hair, and closure of the epiphyses. These previously established effects would be maintained by the androgens, which still remain

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in the body following surgical castration. Development of a wide flat pelvis and loss of facial hair are associated with estrogen’s effects.

Ans: B

Feedback: Each ovum is contained in a storage site called a follicle. The follicles act as endocrine glands producing the hormones estrogen and progesterone. The primary goal of these hormones is to prepare the body for pregnancy and to maintain the pregnancy until birth. Although secretion of these hormones develops the body’s reproductive system and initiates the change into puberty, these occur to prepare the body for pregnancy, the primary goal of the hormones.

Format: Multiple Selection Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember

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Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 680, Female Reproductive System: Menopause 12. As a woman goes through menopause, what expected changes happen? Select all that apply. A) increased production of gonadotropin-releasing hormone (GnRH) by the hypothalamus B) gradual reversal of primary sex characteristics C) loss of calcium retention in bones D) increased serum lipid levels E) decreased serum levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH)

Ans: A, C, D

Feedback: The follicles contained in the ovary become depleted over time, the ovaries no longer produce estrogen and progesterone, and menopause begins with the cessation of menses. The hypothalamus and pituitary gland produce increased levels of GnRH, FSH, and LH for a while in an attempt to stimulate the ovaries to produce estrogen and progesterone. If that does not happen, the levels of these hormones fall back within a normal range in response to their own negative feedback systems. Menopause is associated with loss of many effects of these two hormones resulting in loss of calcium in the bones, increased serum lipid levels, and maintenance of secondary sex characteristics. Primary sexual characteristics are not impacted.

Format: Multiple Choice Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 3 Page and Header: 677, Effects of Estrogen: Box 39.1 13. A school nurse works with many preadolescent and adolescent female clients. Which client would most likely have delays in developing and maintaining the female reproductive organs? A) a client who has low levels of estrogen B) a client with higher-than-average levels of progesterone C) a client whose blood work reveals the presence of androgens D) a client whose levels of follicle-stimulating hormone are slightly below norms

Ans: A

Feedback: Estrogens are responsible for developing and maintaining the female reproductive organs; a deficiency could affect growth and development. Progesterone is the most important hormone for conditioning the endometrium in preparation for implantation of the fertilized ovum. Androgens, secreted by the ovaries in small amounts, are involved in the early development of the follicle and affect the female libido, so their presence is expected. Follicle-stimulating hormone is responsible for stimulating the ovaries to secrete estrogen; a slight decrease would not likely have a major effect.

Format: Multiple Choice Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3 Page and Header: 680, Male Reproductive System: Control Mechanisms 14. What physiologic process would most directly cause spermatogenesis in an adult male client? A) passage of more than 48 hours since ejaculation

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B) synthesis and release of gonadotropin-releasing hormone (GnRH) by the hypothalamus C) increased release of follicle-stimulating hormone (FSH) by the anterior pituitary D) recent sexual stimulation that has not resulted in ejaculation

Ans: C

Feedback: FSH directly stimulates the seminiferous tubules to produce sperm, a process called spermatogenesis. GnRH causes FSH release, so it is an indirect influence of spermatogenesis. Absence of ejaculation causes an accumulation of sperm but does not provide the physiologic impetus for spermatogenesis.

Format: Multiple Choice Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 680, Male Reproductive System: Control Mechanisms 15. The nurse is assessing a client who is known to have a low sperm count. What naturally occurring substance should the nurse identify as affecting only sperm production? A) estrogen B) testosterone C) gonadotropin-releasing hormone (GnRH) D) inhibin

Ans: D

Feedback: Inhibin has been investigated for many years as a possible male birth control drug, because it is thought to affect only sperm production. Estrogen,

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testosterone, and GnRH have multiple effects on the body other than just sperm production.

Format: Multiple Selection Chapter: 39 Client Needs: Health Promotion and Maintenance Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 682, The Human Sexual Response 16. The school nurse is teaching students about sexual health and explains that the effects of arousal include what? Select all that apply. A) increased heart rate B) decreased blood pressure C) sweating D) pupil constriction E) increased blood glucose levels

Ans: A, C, E

Feedback: The sympathetic stimulation that results from sexual stimulation causes increased heart rate, increased blood pressure, sweating, pupil dilation, glycogenolysis (breakdown of stored glycogen to glucose for energy), and other sympathetic responses.

Format: Multiple Choice Chapter: 39 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 2, 5 Page and Header: 682, The Human Sexual Response 17. What client should the nurse assess most closely to determine whether sexual activity will be safe? A) the client with benign prostatic hypertrophy B) the client with a cardiovascular disease C) the client who is postmenopausal with vaginal dryness D) the client with chronic obstructive pulmonary disease (COPD)

Ans: B

Feedback: The stimulation of the sympathetic nervous system that occurs with sexual response could be dangerous in some cardiovascular conditions if they are exacerbated by sympathetic effects, so the client with a cardiovascular disease would require further assessment. Many clients with cardiovascular disease maintain a satisfactory sex life, but each requires careful assessment to determine who might be at risk. The client with benign prostatic hypertrophy can safely participate in sex if they are capable of obtaining an erection. The postmenopausal woman can use lubricants to reduce dryness and make sexual activity more comfortable. The client with COPD may have to limit physical exertion, but there is less likely to be a safety risk.

Format: Multiple Choice Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 3, 4 Page and Header: 676, Female Reproductive System: Structures 18. The nurse working with obstetric clients understands the role of the placenta includes what? A) hormone production

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B) physical protection C) production of glucose D) expelling the fetus

Ans: A

Feedback: The uterus is a muscular organ, which can develop a blood-filled inner lining or endometrium, which will support the development of the placenta, which provides nourishment for the developing fetus and acts as an endocrine gland producing the hormones needed to maintain the active metabolic state of the pregnancy. The amniotic sac protects the fetus. Although nutrients are sent to the growing fetus through the placenta, glucose is not produced by the placenta. The muscles in the uterus contract to expel both the fetus and the placenta.

Format: Multiple Choice Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 680, Male Reproductive System: Hormones 19. The nurse is caring for a client scheduled for removal of both testes secondary to cancer. The client voices concern that he will look like a woman if he doesn’t take testosterone supplementation, which is contraindicated by testicular cancer. The nurse explains that he will maintain his masculine traits as the result of what action? A) residual testosterone found in muscle cells B) hormones secreted by the penis during arousal C) androgens secreted by the adrenal glands D) supplemental medications taken daily

Ans: C

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Feedback: The androgens released by the adrenal glands are sufficient to sustain male sexual characteristics. Androgens are very similar in structure to testosterone and are able to influence cells to maintain the changes caused by testosterone. No residual testosterone is found in muscle cells, the penis does not secrete hormones, and supplemental medications are not required.

Format: Multiple Choice Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 678, Female Reproductive System: Factors Influencing Control Mechanisms 20. The nurse is caring for a female professional athlete who reports not having a menstrual period for 6 months, since the client started training for professional tryouts. The nurse suspects the root cause of this client’s amenorrhea is what? A) hypothalamus is not releasing gonadotropin-releasing hormone (GnRH) B) absence of estrogen production C) increased production of follicle-stimulating hormone (FSH) D) decreased production of progesterone

Ans: A

Feedback: Enormous amounts of energy are expended in reproduction, and if the body needs energy for other reasons, such as this client’s tremendous energy output while training, the hypothalamus shuts down the reproductive activities, stopping the release of GnRH, which results in no FSH or luteinizing hormone (LH) release and no stimulation of the follicles. Estrogen and progesterone production are not impacted, and FSH production decreases.

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Format: Multiple Choice Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 677, Effects of Progesterone: Box 39.2 21. The client asks, “Why do I feel so bloated before my menstrual period begins? I am constipated, my breasts are tender, and I’m always hungry.” How would the nurse best respond? A) “This is the result of the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), hormones to start your period.” B) “This is the result of estrogen release preparing your body to release an ovum.” C) “These are the effects of progesterone, a hormone released to thicken your uterine lining.” D) “This is the result of the secretory endometrium release preparing the body for pregnancy.”

Ans: C

Feedback: Increased body temperature, increased appetite, breast tenderness, bloating, abdominal fullness, and constipation result from the effects associated with progesterone, which is released into the system when the follicle ruptures. These symptoms are not related to FSH and LH. Estrogen may cause mild bloating and water retention, but the more significant symptoms reported by this client in conjunction with other symptoms is not caused by estrogen. Secretory endometrium causes production of glucose and other nutrients to nurture a growing embryo and does not produce the reported symptoms.

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Ans: D

Feedback: During the first 14 days of the menstrual cycle, the woman’s cervical mucosa become thin, creating a risk for infection. Water retention can cause fluid volume excess, not deficit. Disruptions in urinary function or thermoregulation are not typical.

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23. A 74-year-old male client sought care wanting to have his testosterone levels assessed. Results of testing revealed that the client’s testosterone levels were below reference ranges for adult males. What should the nurse teach the client about this finding? A) “More than likely, this is a natural, age-related change in your hormone levels.” B) “Many men who are over 65 find that increasing their level of physical activity can increase testosterone levels.” C) “It’s normal for testosterone production to cease between the ages of around 65 and 70.” D) “For many men, depression causes a drop in testosterone, while a drop in testosterone also contributes to depression.”

Ans: A

Feedback: With age, the seminiferous tubules and interstitial cells atrophy and the male climacteric or andropause, a period of lessened sexual activity and loss of testosterone effects, occurs. This is a normal, age-related change. Testosterone production normally slows, but it does not cease. There are not notable relationships between exercise and testosterone production nor depression and testosterone production.

Format: Multiple Choice Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 678, Female Reproductive System: The Menstrual Cycle 24. The nurse reviews the female client’s laboratory results and finds that the level of gonadotropin-releasing hormone (GnRH) has increased significantly since yesterday. When assessing this client, what will the nurse expect to find?

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A) The client is pregnant. B) The client’s menses have begun. C) The client is ovulating. D) The client is preparing to give birth.

Ans: B

Feedback: The dropping levels of estrogen and progesterone trigger the release of gonadotropin-releasing hormone (GnRH) and then follicle-stimulating hormone (FSH) and luteinizing hormone (LH) again, along with the start of another menstrual cycle. Lowered hormone levels cause the inner lining of the uterus to slough off because it is no longer stimulated by the hormones, demonstrated by the beginning of menses. The client is not pregnant or ovulating at the start of another menstrual cycle nor is the client preparing to birth a baby.

Format: Multiple Selection Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 678, Female Reproductive System: Factors Influencing Control Mechanisms 25. Which female clients are likely to experience a negative impact on their reproductive cycles related to the controls of the hypothalamus? Select all that apply. A) a young adult client who has been on an extreme weight loss plan for several months B) a client who works outdoors all day in a dry, moderate climate C) a client who is moderately obese D) a client who is undergoing treatment for major depression E) a triathlete who is training intensively for an important competition

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Ans: A, D, E

Feedback: In addition to stress, starvation, extreme exercise, and emotional problems are all associated with a decrease in reproductivity related to the controls of the hypothalamus. Extreme temperatures and moderate obesity have not been found to have a negative impact on the reproductive cycle relative to the hypothalamus.

Format: Multiple Selection Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 678, Female Reproductive System: The Menstrual Cycle 26. The nurse is caring for a female client who is on day 14 of her menstrual cycle and ovulation is thought to have just occurred. What assessment findings should the nurse attribute to this? Select all that apply. A) The client states she had a loose bowel movement this morning. B) The client describes a sensation of abdominal fullness. C) The client states she is hungrier than usual. D) The client describes symptoms of anxiety. E) The client reports feeling bloated.

Ans: B, C, E

Feedback: The woman experiences increased body temperature, increased appetite, breast tenderness, bloating and abdominal fullness, constipation, among other symptoms—the effects associated with progesterone, which is released into the system when the follicle ruptures. Anxiety is not expected.

Format: Multiple Choice

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Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 678, Female Reproductive System: The Menstrual Cycle 27. As the lining of the uterus sloughs away, clotting at the site of the separating blood vessels in the uterus is prevented by what factor? A) plasminogen B) fibrinolysis C) luteinizing hormone (LH) D) follicle-stimulating hormone (FSH)

Ans: A

Feedback: High levels of plasminogen in the uterus prevent clotting of the lining as the vessels shear off. Fibrinolysis, LH, and FSH do not contribute to clot prevention.

Format: Multiple Choice Chapter: 39 Client Needs: Health Promotion and Maintenance Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 679, Female Reproductive System: Pregnancy 28. The nurse expects the level of what substance to increase to stimulate uterine contraction and the onset of labor? A) follicle-stimulating hormone (FSH) B) progesterone C) estrogen

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D) prostaglandins

Ans: D Feedback: Local prostaglandins are released stimulating the uterus to contract and the onset of labor begins. High levels of estrogen and progesterone support the uterus and block uterine contractions. FSH is not responsible for the onset of labor.

Format: Multiple Choice Chapter: 39 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 680, Female Reproductive System: Menopause 29. The nurse is caring for a woman who went through menopause 5 years earlier. The nursing plan of care for this client includes teaching related to the importance of what dietary change? A) increased intake of fatty foods to maintain lipid levels B) reduced caloric intake because of lower activity levels C) increased calcium intake to reduce calcium loss in bones D) increased fluid intake to prevent dehydration from increased urination

Ans: C

Feedback: Estrogen and progesterone levels are reduced in menopause resulting in loss of protective mechanisms provided by these hormones. The client requires extra calcium intake to prevent osteoporosis caused by loss of calcium in the bones. Serum lipid levels rise after menopause, thus putting the woman at increased risk of heart disease, so the client should be taught to limit fat intake. Postmenopausal women’s activity levels do not need to decline, and they may be as active as they wish to be. No need exists for increased fluid intake secondary to menopause.

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Format: Multiple Choice Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 680, Male Reproductive System: Structures 30. The parents of an infant boy have been told surgery is needed because their son’s testes have not descended into the scrotal sac. The parents ask the nurse, “Why is the surgery needed?” What is the nurse’s best response? A) “The testes need to be placed in the scrotum to protect sperm-producing cells from body heat.” B) “If the testes remain in the abdomen, it will help to protect them from accidental trauma.” C) “Leaving the testes in the abdomen would damage their ability to produce testosterone.” D) “The risks associated with surgery are greater than the risks associated with leaving the testes in the abdomen.”

Ans: A

Feedback: During fetal development, the two testes migrate down the abdomen and descend into the scrotum outside the body where they are protected from the heat of the body to prevent injury to the sperm-producing cells. Leaving them in the abdomen would not protect them, testosterone production would not be impacted, and the risk to sperm production is far greater than surgical risks.

Format: Drag and Drop Chapter: 39

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Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1, 3 Page and Header: 678, Female Reproductive System: The Menstrual Cycle 31. The school nurse is teaching some adolescent girls about the physiology of the menstrual cycle. In what sequence should the nurse describe the following events? A) Follicles are stimulated and release estrogen. B) GnRH is released by the hypothalamus. C) Ovulation takes place. D) Reduced levels of estrogen and progesterone cause the uterine lining to slough. E) The anterior pituitary releases FSH and LH.

Ans: B, E, A, C, D

Feedback: The menstrual cycle ultimately begins with the release of GnRH, which stimulates FSH and LH release from the anterior pituitary. Follicles respond to FSH and LH by releasing estrogen. By about day 14, the estrogen levels have caused the LH surge, and ovulation occurs. If pregnancy does not occur, after about 14 days, the corpus luteum involutes, and the levels of estrogen and progesterone drop off. Lowered hormone levels also cause the inner lining of the uterus to slough off because it is no longer stimulated by the hormones.

Format: Multiple Selection Chapter: 39 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 682, Effects of Testosterone: Box 39.3

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32. The nurse is caring for an adolescent boy who is suspected of taking supplemental testosterone to improve his performance as a wrestler. What assessment findings would support this suspicion? Select all that apply. A) excessive hair growth on the face and body B) enlarged muscular development C) reduced hematocrit levels D) growth of testes and scrotal sac E) increased thickening of the skin

Ans: A, B, D, E

Feedback: Testosterone is responsible for hair growth on the body and face, muscle development, increased hematocrit levels, growth of testes and scrotal sac, and increased thickening of the skin. Hematocrit would not be affected.

Format: Multiple Choice Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 3 Page and Header: 682, Male Reproductive System: Andropause 33. The nurse is talking with a woman about menopause when the woman turns to her husband and says, “You’re so lucky not to have to go through anything like this!” What is the nurse’s best response? A) “Men go through something called andropause when less testosterone is produced.” B) “Men are fortunate to maintain the same hormone levels throughout their life.” C) “With age, sexual function declines but that is not due to hormonal changes in men.” D) “The ability to obtain and maintain an erection will decline with age.”

Ans: A

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Feedback: With age, the seminiferous tubules and interstitial cells atrophy and the male climacteric or andropause, a period of lessened sexual activity and loss of testosterone effects, occurs. This indicates a decline in hormone levels in men similar to what women experience. Sexual function and the ability to obtain and maintain an erection do not occur in all men but usually is most often seen in those with problems such as hypertension, diabetes, and heart disease. Healthy men who make healthy lifestyle choices can maintain sexual activity well into their senior years.

Format: Multiple Choice Chapter: 39 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 679, Female Reproductive System: Pregnancy 34. A female client with her newborn infant arrives at the clinic for a COVID-19 booster. The client asks the nurse, “When should I expect to have a menstrual period now that the baby is here?” What assessment question should the nurse ask in order to provide the client with an accurate answer? A) “When was the infant born?” B) “Are you using a form of birth control?” C) “Is this your only child?” D) “Were your periods regular before your pregnancy?”

Ans: A Feedback: It often takes 6 to 8 weeks for stabilization of the hormonal cycle after labor and birth so determining when the baby was born is the basis for an accurate answer. None of the other options are related to determining the hormonal stabilization following a pregnancy.

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Test Generator Questions, Chapter 40, Drugs Affecting the Female Reproductive System Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 695, Estrogen Receptor Modulators: Contraindications and Cautions 1. The nurse is caring for a client who would like to start taking oral contraceptives. What aspect of this client’s health history should the nurse prioritize for follow-up? A) The client’s body mass index (BMI) is 18.0. B) The client uses marijuana one to two times per week. C) The client takes ibuprofen for the treatment of headaches and joint pain. D) The client was treated for deep vein thrombosis following surgery.

Ans: D

Feedback: Estrogens are contraindicated in the presence of a history of thromboembolic disorders because of the increased risk of thrombus and embolus development. The client’s BMI is not prohibitively low, and the use of NSAIDs, such as ibuprofen or marijuana, is not absolutely contraindicated with oral contraceptives.

Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 4 Page and Header: 688, Combination Drugs Used for Menopause: Box 40.2 2. The nurse is caring for a client with an intact uterus who requests hormone replacement for short-term use to reduce menopausal symptoms. What combination drug would be appropriate for this client? A) Estradiol (Estrace) B) Estrogens/medroxyprogesterone (Premphase) C) Estrogens, conjugated (Premarin) D) Estrogens, esterified (Estratab)

Ans: B

Feedback: The client would be given estrogens/medroxyprogesterone (Premphase) because it is a combination of estrogen and progesterone. The combination is important to help avoid risk of endometrial hyperplasia. Estradiol (Estrace), estrogens, conjugated (Premarin), and estrogens, esterified (Estratab) contain only estrogen, so they are not combination drugs.

Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 687, Drugs in Focus: Sex Hormones and Estrogen Receptor Modulators: Table 40.1 3. The nurse is caring for a client who just had subdermal implantation of etonogestrel. What should the nurse teach the client about this intervention? A) The implant will prevent pregnancy until the client reaches menopause, barring any complications.

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B) The implant confers minimal protection against bacterial sexually transmitted infections. C) The client will need to have serum levels of progesterone drawn in 1 month. D) The implant should be replaced in around 3 years.

Ans: D

Feedback: Etonogestrel, in addition to being available as a vaginal ring, NuvaRing, is available as a subdermal implant that may be left in place for up to 3 years and then must be removed. Another implant could be placed at that time. Like all forms of hormonal contraception, there is no protection against STIs. Follow-up blood work is not necessary.

Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 2 Page and Header: 694, Focus on Herbal and Alternative Therapies: Box 40.7 4. A female client with a history of perimenopausal symptoms tells the nurse she is taking soy, calcium, and a multivitamin as an alternative to taking hormone replacement pills. What is the nurse’s priority response? A) Increase her iron supplement. B) Discontinue her calcium supplement. C) Decrease the amount of carbohydrates in her diet. D) Increase calcium supplementation.

Ans: B

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Feedback: The nurse may advise the client to stop using a calcium supplement because soy is not to be taken with calcium, iron, or zinc. However, the client may have to decide whether it would be more beneficial for her to continue the calcium and discontinue the soy if osteoporosis is a concern. Decreasing carbohydrates is a healthy choice, especially for a menopausal woman, but would not be the priority concern.

Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 694, Sex Hormones: Progestins: Clinically Important Drug–Drug Interactions 5. A client diagnosed with a seizure disorder taking phenytoin requests a prescription for an oral contraceptive. What is the nurse’s best response? A) “Taking phenytoin at the same time as oral contraceptives could make the adverse effects worse.” B) “The effectiveness of oral contraceptives might be reduced by phenytoin.” C) “You’re likely to have an increase in your risk for seizures, so check with your neurologist first.” D) “Check with the prescriber, but you will likely need to increase the dosage of your phenytoin once you start contraceptives.”

Ans: B Feedback: The effectiveness of oral contraceptives containing estrogen, progestin, or both will be reduced by phenytoin, so contraceptives will not be adequate to prevent pregnancy. There is no reason to change the dosage of phenytoin and doing so could increase the client’s risk for seizures. Phenytoin would not make the adverse effects of oral contraceptives worse.

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Ans: B

Feedback: The use of a progestin vaginal gel is associated with breast enlargement. Constipation, not diarrhea, is also an adverse effect. Abdominal pain with progestin therapy is associated with the use of an intrauterine device for birth control, not a vaginal gel. Local skin irritation can result from use of a dermal patch contraceptive.

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7. The nurse is preparing to administer an infusion of oxytocin to the pregnant client. What is the priority assessment before beginning the infusion? A) measuring cervical dilation B) determining cephalopelvic proportions C) reviewing electrocardiogram readings D) evaluating respiratory excursion

Ans: B

Feedback: Oxytocin is used to stimulate labor and often results in intense uterine contractions. It is important that the nurse assess cephalopelvic proportions because a disproportion between the size of the baby and the size of the fetus could result in serious complications. Dilation may be well underway when oxytocin is started or may need to be initiated, so this is not the priority assessment over cephalopelvic proportions, although it would certainly be assessed. Respiratory excursion is expected to be limited in pregnant women because of the enlarged uterus pushing up on the diaphragm. Electrocardiogram readings should not be needed with most pregnant women unless the woman has a preexisting cardiac condition.

Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 701, Oxytocics and Abortifacients; 702, Uterine Motility Drugs: Therapeutic Actions and Indications 8. A nurse has administered a prescribed dose of dinoprostone intravaginally. What outcome best indicates a therapeutic response? A) relief from menopausal symptoms B) contractions less than 5 minutes apart

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C) the pregnancy is terminated D) no pregnancy within the next 6 months

Ans: C

Feedback: Dinoprostone is the prototype abortifacient; the goal of administration is to terminate the pregnancy, not to stimulate labor, relieve menopausal symptoms, or prevent a future pregnancy.

Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 687, Drugs Affecting the Female Reproductive System, Children: Box 40.1 9. A 14-year-old client is started on oral contraceptives. When following this client in the clinic, what is the nurse’s priority assessment? A) closure of the epiphyses B) menstrual patterns C) nutrition D) cognitive development

Ans: A

Feedback: A 13-year-old girl is still growing. Estrogens and progestins have undergone limited testing in children. Because of their effects on closure of the epiphyses, they should be used only with great caution in growing children. It is important for the nurse to monitor metabolic and other effects as well. Menstrual patterns, nutrition, and

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cognitive development are all components of care of the adolescent, but they are not the priority consideration.

Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 694, Sex Hormones: Clinically Important Drug–Drug Interactions, Estrogens 10. A client is in the clinic for a follow-up visit after having been on hormone replacement therapy for 3 months. Which report by the client should be the priority concern for the nurse? A) smoking 8 to 10 cigarettes a day B) 10-lb (4.5-kg) weight gain in the last 3 months C) occasional binge eating D) almost no exercise

Ans: A

Feedback: All these options are poor health habits and will impact the client’s health. However, the immediate concern is smoking. The nurse should stress that women who take estrogen should not smoke because of the increased risk for thrombotic events. A weight gain of 10 lb (4.5 kg), binge eating, and a decrease in exercise would not be as immediate a concern, although the nurse should address these issues.

Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Reduction of Risk Potential

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Cognitive Level: Remember Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 693, Sex Hormones: Contraindications and Cautions: Progestins 11. The nurse is caring for a 33-year-old mother of two who has a history of asthma and migraine headaches. The client is on a low-residue diet for colitis. What factor in the client’s history may contraindicate the use of birth control pills? A) migraine headaches B) age C) asthma D) colitis

Ans: A

Feedback: Progestins should be used with caution in clients with epilepsy, migraine headaches, asthma, or cardiac or renal dysfunction because of the potential exacerbation of these conditions. Age, asthma, and colitis would not be cautions or contraindications for the use of oral contraceptives.

Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 687, Table 40.1. Drugs in Focus: Sex Hormones and Estrogen Receptor Modulators 12. The nurse is caring for a postmenopausal client who is taking estradiol to reduce signs and symptoms of menopause. The nurse explains to the client that this medication will also reduce the risk for which condition?

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A) endometriosis B) dysfunctional uterine bleeding C) osteoporosis D) uterine cancer

Ans: C

Feedback: Estrogen slows the bone loss seen with osteoporosis, so this will be an added benefit of the drug. Observe for improved bone density tests and absence of fractures. Endometriosis and dysfunctional uterine bleeding do not occur in postmenopausal women who no longer menstruate. Estrogen does not prevent uterine cancer, and screening for cancer should be performed before this drug is prescribed.

Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 5 Page and Header: 689, Contraceptives: Forms and Dosing: Box 40.3 13. The nurse has been conducting client teaching for a 16-year-old female who is starting oral contraception. What statement indicates that the client needs additional teaching? A) “I will be sure to monitor my weight and have my blood pressure checked regularly.” B) “I will see my primary health care provider and have a Pap smear done on a yearly basis.” C) “If I forget to take my pill for 2 consecutive days, I will take three pills to catch up.” D) “I will take the contraceptive pill every day at the same time and aim to never miss a pill.”

Ans: C

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Feedback: If one tablet is missed, the client should be taught to take it as soon as possible or take two tablets the next day. If two consecutive tablets are missed, take two tablets daily for the next 2 days; then resume the regular schedule. If three consecutive tablets are missed, begin a new cycle of tablets 7 days after the last tablet was taken, and use an additional method of birth control until the start of the next menstrual period. The other statements are accurate and denote the client understood the nurse’s teaching.

Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 689, Contraceptives: Forms and Dosing: Box 40.3 14. The female client presents to the health clinic to ask about emergency contraception. The client is prescribed levonorgestrel. What should the nurse teach the client about this medication? A) “You need to take one tablet as soon as possible after having unprotected intercourse.” B) “Take one tablet within 72 hours of unprotected intercourse and another 12 hours later.” C) “Take one tablet whenever you are likely to have unprotected intercourse in the next 12 hours.” D) “Make sure that any effects of alcohol have fully worn off before you take the prescribed tablet.”

Ans: B

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Feedback: Levonorgestrel is taken within 72 hours of unprotected intercourse with another tablet taken 12 hours after the first. It is not taken before unprotected intercourse. Taking it while alcohol is still be metabolized is not contraindicated.

Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 4 Page and Header: 695, Estrogen Receptor Modulators: Adverse Effects 15. The nurse is caring for a client taking raloxifene. What manifestation reported by the client would raise the highest level of concern from the nurse? A) headache B) weight loss C) calf pain D) peripheral edema

Ans: C

Feedback: The highest level of concern would be calf pain because it could indicate a possible venous thrombosis that has the potential to be life threatening. Raloxifene has been associated with GI upset, nausea, and vomiting. Changes in fluid balance may also cause headache or edema, but this is a lower priority than possible thromboembolism. Weight loss is not a priority concern unless it is excessive.

Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember

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Difficulty: Easy Integrated Process: Teaching/Learning Objective: 5 Page and Header: 689, Contraceptives: Forms and Dosing, Box 40.3 16. An adolescent client asks the nurse, “What should I do if I forget to take my birth control pill?” How should the nurse respond? A) “Abstain from intercourse for 7 days.” B) “It’s okay to miss a day or two, as long as you don’t go over 3 days.” C) “Just wait until your next dose and then take double the dose.” D) “Take the dose as soon as you discover your oversight.”

Ans: D

Feedback: A missed pill should be taken as soon as the error is noticed. Telling the client to abstain from intercourse would be inappropriate, but if the client misses three tablets, they should use another form of birth control until the next cycle of pills is started. It is not okay to miss a dose, and the highest protection is provided when the pill is taken daily without missing a dose. The sooner the missed dose is taken, the better contraceptive protection provided, so clients should not wait until the next dose and then double it.

Format: Multiple Selection Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 702, Uterine Motility Drugs: Oxytocics and Abortifacients: Contraindications and Cautions 17. The nurse is reviewing a client’s medical record. The presence of what health problems would contraindicate the safe use of an abortifacient? Select all that apply.

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A) cephalopelvic disproportion (CPD) B) coronary artery disease (CAD) C) hepatic disease D) orthostatic hypotension E) type 2 diabetes

Ans: A, B, C

Feedback: Abortifacients should not be used when CPD, CAD, or hepatic disease is found to be in the client’s history. Orthostatic hypotension or type 2 diabetes would not contraindicate the use of an abortifacient. Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 703, Nursing Considerations for Patients Receiving Oxytocics or Abortifacients: Nursing Conclusions 18. The nurse is developing a nursing plan of care for a client who will receive a fastacting abortifacient. What nursing diagnosis is most likely to apply to care provided shortly after administering the medication? A) acute pain related to uterine contractions B) disturbed body image related to termination of pregnancy C) risk for fluid volume deficit related to blood loss, diarrhea, and diaphoresis D) deficient knowledge regarding drug therapy

Ans: A

Feedback: The rapid-acting abortifacients work within 10 to 15 minutes, so shortly after administration of the drug, the client will begin to have acute abdominal pain. Only after uterine contents are evacuated would the risk for fluid volume imbalance occur.

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Deficient knowledge regarding drug therapy should have been addressed before administering the medication. There is no reason to presume that the client’s body image will be affected.

Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 693, Treating Dyspareunia during Menopause: Box 40.5 19. A client has been prescribed ospemifene. When preparing to provide medication education on the drug, the nurse will include which instruction? A) “Let your primary health care provider know immediately if you begin to experience pain during intercourse.” B) “Hot flashes and vaginal discharge are adverse effects that require terminating the medication.” C) “Schedule follow-up visits at least twice a year to determine if it’s appropriate to continue with the therapy.” D) “Research has proven that ospemifene decreases the risk of developing endometrial cancer.”

Ans: C

Feedback: Ospemifene is used for the treatment of moderate to severe dyspareunia during menopause and for treatment of moderate to severe vaginal dryness. Dyspareunia is a condition of painful intercourse associated with the vaginal dryness and changes that occur with menopause. Because of the potential risk associated with the use of the drug, it is recommended that every 3 to 6 months the use of the drug be reevaluated. The use of ospemifene may increases the risk of endometrial cancer. When

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taking the drug, clients may experience hot flashes, vaginal discharge, muscle spasms, and increased sweating.

Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 689, Contraceptives: Forms and Dosing, Box 40.3 20. The nurse is caring for a female client with a new prescription for oral contraceptives. What outcome would be most important for the nurse to evaluate? A) The client describes having a positive attitude toward sexual behavior. B) The client can explain how medication cannot prevent most sexually transmitted infections. C) The client can verbalize how and when to take medication even if a pill is missed. D) The client indicates when it is appropriate to make appointments for follow-up care.

Ans: C

Feedback: It is most important for the nurse to evaluate the client’s understanding of how to take the medication properly, including how to respond when a pill is missed. Oral contraceptives will not prevent against any sexually transmitted infections. Although making follow-up appointments is good, it is more important that the client know how to take the medication. The client’s attitude toward sexuality is relevant to the nurse and to the client’s well-being, but taking the medication, so it will have its intended effect is the priority.

Format: Multiple Selection Chapter: 40

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 692, Focus on The Evidence: Menopause and Hormone Replacement Therapy—The Women's Health Initiative Study: Applying the Evidence, Box 40.4 21. The nurse is discussing the advantages and disadvantages of hormone replacement therapy (HRT) with a female client. What statement demonstrates the nurse’s understanding and willingness to effectively counsel the client during the decisionmaking process? Select all that apply. A) “The information we are about to discuss is the most current guidelines available.” B) “You are not alone; many women find it frustrating to comprehend all the relevant information on HRT.” C) “I’ve provided you with a written copy of some reliable online resources concerning HRT.” D) “Let’s discuss any concerns you have about beginning the medication therapy.” E) “I understand this is a difficult decision; here is a number where I can be reached if you have concerns in the future.” Ans: A, B, C, D, E Feedback: A client entering menopause should have all of the information available before making the difficult decision whether HRT is appropriate treatment. The nurse is often in the best position to provide information, listen to concerns, and help the client to decide what is best. This can be a frustrating time, so the client will need a consistent, reliable person to turn to with questions and for support.

Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process

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Objective: 3, 5 Page and Header: 699, Fertility Drugs 22. A 33-year-old client has been prescribed clomiphene. What outcome best indicates successful therapy to the nurse? A) Pregnancy occurs. B) Preterm labor ceases. C) Menopausal symptoms are relieved. D) Regular menstrual periods resume.

Ans: A

Feedback: Clomiphene is prescribed exclusively for infertility. As a result, pregnancy is the desired outcome. It is not prescribed for relief of menopausal symptoms, disruptions in menstrual cycles, or preterm labor.

Format: Multiple Selection Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 703, Uterine Motility Drugs: Adverse Effects 23. The nurse assesses the postpartum client who has been receiving methylergonovine and suspects ergotism when what manifestations are found? Select all that apply. A) weak pulse B) dyspnea C) numb cold extremities D) chest pain E) postpartum hemorrhage

Ans: A, B, C, D

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Feedback: Ergonovine and methylergonovine can produce ergotism, manifested by nausea, blood pressure changes, weak pulse, dyspnea, chest pain, numbness and coldness in extremities, confusion, excitement, delirium, convulsions, and even coma. Postpartum hemorrhage can occur as an adverse effect of ergonovine but is not a manifestation of ergotism.

Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 699, Therapeutic Actions and Indications 24. A couple presents to the fertility clinic for help in getting pregnant, and the nurse administers follitropin alfa to the male partner. How would the nurse describe how this drug work? A) stimulates FSH secretion from the pituitary B) stimulates LH release from the anterior pituitary C) stimulates spermatogenesis D) increases the effects of existing testosterone

Ans: C

Feedback: Follitropin alfa stimulate spermatogenesis in men with low sperm counts and otherwise normally functioning testes. Menotropins do not stimulate FSH and LH levels, though menotropins mimic the effects of these hormones. Menotropins do not potentiate the effects of testosterone.

Format: Multiple Choice Chapter: 40

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 705, Nursing Considerations for Patients Receiving Tocolytics: Intervention with Rationale 25. The nurse is caring for a client in labor who is receiving an oxytocin infusion. What action should the nurse prioritize? A) providing emotional support to the client B) monitoring the fetal heart rate C) monitoring the client’s pain levels D) ensuring the client changes position at least once every 15 minutes

Ans: B

Feedback: Close monitoring of the fetal heart rate is a major priority in the care of a client receiving an oxytocin infusion. Providing support and monitoring pain are also important, but the FHR is the highest priority since it has the closest link to successful outcomes (i.e., healthy birth). Position changes are a lower priority, except as they affect the FHR.

Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 692, Menopause and Hormone Replacement Therapy—The Women's Health Initiative Study, Box 40.4

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26. The nurse is talking with a menopausal woman about the use of hormone replacement therapy (HRT). What statement, if made by the nurse, would be accurate and appropriate to share with the client? A) Symptoms of menopause are short-term and minor, so taking HRT is not necessary. B) The newer drugs used in HRT cause cardiovascular events even when taken shortterm. C) Research shows that the risk for osteoporosis is much higher in female clients who take HRT. D) There is a possible increased risk of breast and cervical cancer when taking HRT.

Ans: D

Feedback: The use of HRT can decrease the discomforts associated with menopause, although various forms of HRT have been associated with increased risks of breast and cervical cancer, heart disease, and stroke. The newer drugs used in HRT have been shown to be associated with only a possible increase in risk of breast and cervical cancer, but with long-term use, they are associated with an increased risk of cardiovascular events. The risk for osteoporosis declines with HRT because of the bone saving effects of the drugs. It would be inappropriate and judgmental for the nurse to say symptoms of menopause are minor because some women experience more severe symptoms that can negatively impact their day-to-day life.

Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 699, Fertility Drugs: Therapeutic Actions and Indications 27. The nurse is caring for an infertile couple who plan to take chorionic gonadotropin in an attempt to become pregnant. How should the nurse describe the action of this drug?

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A) affecting FSH and LH release B) stimulating follicular development C) stimulating maturation of ova D) stimulating multiple follicle development

Ans: A

Feedback: Chorionic gonadotropin is used to stimulate ovulation by acting like gonadotropin-releasing hormone (GnRH) and affecting FSH and LH release. It does not stimulate follicular development, maturation of the ova, or multiple follicle development.

Format: Multiple Choice Chapter: 40 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 694, Focus on Herbal and Alternative Therapies, Box 40.7 28. The nurse would question the use of what herbal supplement by a client taking hormone replacement therapy (HRT) containing progesterone? A) dong quai B) devil’s claw C) wild yam D) black cohosh

Ans: C

Feedback: Wild yam contains progesterone. It should not be used with hormone replacement therapy, because it may cause increased blood glucose and other toxic effects. Dong quai, devil’s claw, and black cohosh are not explicitly contraindicated with HRT.

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Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3 Page and Header: 687, Drugs in Focus: Sex Hormones and Estrogen Receptor Modulators, Table 40.1 29. When the nurse learns a male client takes conjugated estrogens. The nurse will question the client about what disorder? A) prostate cancer B) breast cancer C) osteoporosis D) andropause

Ans: A

Feedback: Conjugated estrogen is most commonly taken by men to treat prostate cancer because the estrogen competes with testosterone for binding sites. Although men do get breast cancer and osteoporosis, they would not be treated with estrogen for these disorders. Andropause is caused by a reduction in testosterone, so they would get a male hormone replacement and not estrogen.

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Objective: 2 Page and Header: 700, Drugs in Focus: Fertility Drugs, Table 40.2 30. The nurse is preparing to administer clomiphene to the female client. What dose would the nurse find is within usual dose range? A) 100 mg B) 10 mg C) 1 mg D) 0.1 mg

Ans: A

Feedback: The usual dosage range for clomiphene is 50 to 100 mg/d PO with length of therapy and timing dependent on the particular situation.

Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 689, Contraceptives: Forms and Dosing, Box 40.3 31. The nurse is providing client teaching for a woman who will begin receiving medroxyprogesterone acetate injections. When should the nurse schedule the appointment for the next injection? A) 1 month from last injection B) 3 months from last injection C) 6 months from last injection D) 12 months from last injection

Ans: B

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Feedback: Medroxyprogesterone acetate is administered by deep intramuscular (IM) injection every 3 months.

Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 683, Sex Hormones: Adverse Effects: Estrogens 32. The female client calls the clinic and says, “I just started oral contraceptives last month and am experiencing breakthrough bleeding, fluid retention resulting in edema, changes in libido, and palpitations.” What symptom would the nurse recognize as being caused by a factor other than adverse effects of the oral contraceptive? A) breakthrough bleeding B) fluid retention C) changes in libido D) palpitations Ans: D

Feedback: Palpitations are not commonly associated with contraceptives and so the client would need to be seen and evaluated. The most common adverse effects of estrogens include breakthrough bleeding, menstrual irregularities, dysmenorrhea, amenorrhea, and changes in libido. Other adverse effects can result from the systemic effects of estrogens, including fluid retention, electrolyte disturbances, headache, dizziness, mental changes, weight changes, and edema. GI effects also are fairly common and include nausea, vomiting, abdominal cramps and bloating, and colitis. Potentially serious GI effects, including acute pancreatitis, cholestatic jaundice, and hepatic adenoma, have been reported with the use of estrogens.

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Format: Multiple Choice Chapter: 40 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 693, Sex Hormones: Adverse Effects: Progestins 33. The client calls to report perineal pain and breast enlargement. What medication does the nurse expect to find the client is taking on reviewing the medical record? A) desogestrel B) drospirenone C) progesterone D) norethindrone

Ans: C

Feedback: Perineal pain and breast enlargement results from vaginal gel formulas, so the nurse would suspect the client is receiving progesterone because this is the only progestin administered by this method. The other options are all oral medications that would not cause perineal pain or breast enlargement.

Test Generator Questions, Chapter 41, Drugs Affecting the Male Reproductive System Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 1, 3 Page and Header: 712, Androgens: Adverse Effects 1. A nurse is caring for an adolescent who has been diagnosed with hypogonadism and has been prescribed fluoxymesterone for replacement. The nurse has identified a nursing diagnosis of risk for disturbed body image. What intervention should the nurse perform to best address this diagnosis? A) Provide anticipatory guidance around the prevention and management of acne. B) Dialogue with the client about the potential for gynecomastia. C) Teach the client about the fact that development of facial hair may be delayed. D) Educate the client about strategies for managing fluid volume excess and facial “puffiness.”

Ans: A

Feedback: Androgenic effects include acne. For the adolescent, acne could cause image concerns and could lead to low self-esteem. Androgens would not lead to gynecomastia, delayed development of facial hair, or fluid volume excess.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 712, Androgens: Adverse Effects 2. A postmenopausal client has been diagnosed with breast cancer. The client is being treated with methyltestosterone. What assessment finding would the nurse suspect is a complication from the medication? A) increased blood pressure B) jaundice C) weight loss

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D) high-pitched voice

Ans: B

Feedback: A potentially life-threatening effect of an androgen is hepatocellular cancer. Jaundice would indicate that the liver function has been compromised; not commonly associated with this medication. Usually, weight gain and deepening of the voice are adverse effects of this drug. An increase in blood pressure is not associated with methyltestosterone.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 713, Low-Testosterone Syndrome, Box 41.2 3. The nurse is providing care for a 56-year-old male client who has sought care, stating, “From what I’ve read online, I’m pretty sure that I’ve got low testosterone levels.” What is the nurse’s best action? A) “There are some nondrug strategies for increasing your testosterone levels that I can introduce you to.” B) “This is quite common among men of your age, and it’s fortunate that there are now treatments.” C) “Don’t believe everything you read. The phenomenon of ‘low T’ is actually a fabrication of drug companies.” D) “Some of the effects of decreasing testosterone in adult men have been overstated in the media.”

Ans: D

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Feedback: There is little evidence-based research on the effects of a normally falling level of testosterone associated with age, despite media reports that imply the contrary. The nurse should educate the client accordingly, without being dismissive or condescending. There are not lifestyle modifications that can increase testosterone levels.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 4 Page and Header: 711, Drugs in Focus: Androgens, Table 41.1 4. An older male client, who has difficulty swallowing oral medications, will begin taking an androgen. What drug would the nurse identify as a good choice for this client? A) danazol B) fluoxymesterone C) methyltestosterone D) testosterone

Ans: D

Feedback: A good choice for this client would be testosterone because the drug can be administered in long-acting depository forms, buccal tablets, and by dermatologic patch. These forms would eliminate the need for the client to swallow a pill or tablet. The other options shown here are available only in oral form.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 716, Nursing Considerations for Patients Receiving Androgens/Anabolic Steroids: Nursing Conclusions 5. A 28-year-old female client is taking danazol as treatment for endometriosis. The client is distressed related to increased facial hair, a weight gain of 15 lb (6.8 kg), and a change in her voice. What nursing conclusion would be most appropriate for this client? A) acute pain related to need for injections B) deficient knowledge regarding drug therapy C) disturbed body image related to drug therapy D) sexual dysfunction related to androgenic effects

Ans: C Feedback: The client is concerned about the way she looks and the sound of her voice. The most appropriate nursing diagnosis would be disturbed body image. Danazol is not administered by injections; therefore, acute pain would not be applicable. Sexual dysfunction and deficient knowledge would be possible nursing diagnoses for this client, but the concerns expressed by the client fail to support these diagnoses.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1, 3 Page and Header: 711, Box 41.1 6. A child in renal failure is taking androgens to promote red blood cell production and is seen in the clinic every other month. What adverse drug effect would the nurse monitor for with this child?

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A) epiphyseal closure B) acne C) change in skin color D) weight gain

Ans: A

Feedback: Because of the effects of androgens on epiphyseal closure, children should be closely monitored with hand and wrist radiographs before treatment and every 6 months after treatment. The other options are also adverse effects and require monitoring but are not as serious as premature epiphyseal closure.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 713, Clinically Significant Drug–Drug Interactions 7. A male client is diagnosed with angina, prostate enlargement, and penile erectile dysfunction. The client asks the nurse if he could try tadalafil after seeing an advertisement on television. What client factor should the nurse prioritize for follow-up? A) The client takes isosorbide dinitrate for the treatment of angina. B) The client’s body mass index is 31 kg/m2. C) The client takes tamsulosin for the treatment of benign prostatic hyperplasia. D) The client job involves shift work, and he has erratic sleep habits.

Ans: C

Feedback: Serious drops in blood pressure, leading to potentially fatal myocardial infarction or cerebrovascular event, have been reported when a nitratelike isosorbide

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dinitrate is combined with alpha-adrenergic blockers such as tamsulosin. Diuretics, betablockers, obesity, and sleep disruptions do not present safety threats.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 713, Box 41.3 8. A client who is presents at the clinic for a physical checkup. The client tells the nurse, “I am using large doses of creatine to increase muscle size and strength.” What should the nurse instruct the client to do while taking this medication? A) “Take nonsteroidal antiinflammatory drugs (NSAIDs) to stop pain from expanding muscles.” B) “Be sure you drink plenty of fluids while using this drug and watch for swelling.” C) “You need to stop eating red meat and any other animal products such as dairy and eggs.” D) “Take cimetidine to relieve the stomach upset associated with the use of this therapy.”

Ans: B

Feedback: Creatine is a protein byproduct that has to be processed through the kidneys. If a client is using it to try to increase muscle size, the client should be advised to drink plenty of fluids to help flush it through the kidney and to watch for any swelling that could indicate change in renal function. NSAIDs could aggravate renal problems and cause more swelling. Getting protein from food sources is a natural way to provide the body with proteins. If stomach upset occurs, the client should stop using the herbal therapy and not add another drug to the regimen, especially cimetidine that can increase risk of kidney damage.

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Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3 Page and Header: 711, Box 41.1 9. A 9-year-old male client is taking testosterone injections for treatment of hypogonadism. What should the nurse include in this client’s long-term plan of care? A) annual influenza vaccinations B) thyroid hormone levels every 3 months for the first year C) annual vision testing and optometric assessments D) hand and wrist radiographs every 6 months

Ans: D

Feedback: Because of the effects of these hormones on epiphyseal closure, children should be closely monitored with hand and wrist radiographs before treatment and every 6 months after treatment. It would not be necessary to measure vision and thyroid function, as these are not normally affected. Influenza vaccinations are recommended for all clients who do not have contraindications, but this is unrelated to the use of testosterone.

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Objective: 2 Page and Header: 712, Androgens: Adverse Effects 10. The nurse should assess the client taking anabolic steroids for what serious adverse effect? A) elevated blood urea nitrogen (BUN) B) elevated blood glucose level C) bradycardia D) jaundice

Ans: D

Feedback: Anabolic steroids all have black box warnings as alerts to the potentially serious effects of liver tumors, hepatitis, and blood lipid level changes that might be associated with increased risk of coronary artery disease. As a result, the nurse should assess for jaundice that could be an early indication of liver dysfunction. Elevated BUN, blood glucose levels, and bradycardia are not commonly reported adverse effects.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 710, Androgens: Therapeutic Actions and Indications 11. A male client diagnosed with cancer has developed cachexia and been prescribed anabolic steroids. The client’s most recent laboratory results indicate a hemoglobin levels of 15.8 g/dL (158 g/L). What is the nurse’s best action? A) Assess the client for signs and symptoms of polycythemia. B) Provide assistance with activities of daily living as needed. C) Document the therapeutic effects of treatment.

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D) Collaborate with the care provider to see if the client would benefit from iron supplements.

Ans: C

Feedback: Increased hemoglobin levels are a desired effect of anabolic steroids. This client’s hemoglobin in the high-normal range. Assistance with ADLs is unrelated to this finding, and the client may need less help than before, owing to increased oxygencarrying capacity. There is no obvious indication for iron supplements.

Format: Multiple Selection Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 713, Androgens: Clinically Significant Drug–Drug Interactions 12. The nurse is caring for a client who has been taking androgens and has been admitted to the ICU following a car accident. What lab results will the nurse interpret as more indicative of androgen therapy than actual disease states? Select all that apply. A) decreased thyroid function B) increased creatinine levels C) decreased creatinine clearance D) elevated liver enzymes E) increased white blood cell (WBC) count

Ans: A, B, C

Feedback: When a client is taking androgens, thyroid function may decreased, creatinine levels may increase, and creatinine clearance may decrease; these results are not associated with disease states. These effects can last up to 2 weeks after the

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discontinuation of therapy. Elevated liver enzymes may indicate a potentially lifethreatening effect that has been documented is hepatocellular cancer. Increased WBC count would indicate an infection. Increased liver enzymes and WBC are not associated with androgen therapy but instead indicate a disease state.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 711, Focus on Drug Therapy across the Lifespan: Older Adults, Box 41.1 13. The 63-year-old male client receives a prescription for androgens. The nurse evaluates that the client understood drug teaching when he makes what statement? A) “If I experience oily skin or hair, I will contact my physician immediately.” B) “If I experience flushing, sweating, nervousness, or emotional lability, I’ll know it’s the drug.” C) “I will report any difficulty urinating such as trouble starting my flow.” D) “These pills may make my skin turn yellow, but it will go away when the drug is stopped.”

Ans: C

Feedback: Benign prostatic hypertrophy, a common problem in older men, may be aggravated by androgenic effects that may enlarge the prostate further, leading to urinary difficulties and increased risk of prostate cancer. Nurses should teach these men the signs and symptoms of prostatic enlargement and the importance of reporting these manifestations immediately to prevent worsening of symptoms. Acne need not be reported immediately. Flushing, sweating, nervousness, and emotional lability are more

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usually experienced by women. Yellowing of the skin may be an indication of liver disease, which should be reported immediately.

Format: Fill-in-the-Blank Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 717, Table 41.2 14. A client’s anemia has not responded to conservative treatments, so the client has been prescribed oxymetholone 2.5 mg/kg PO per day. The client weighs 154 lb. How many 50-mg tablets should the client take each day?

Ans: 3.5 tablets

Feedback: The client’s weight should first be converted to kilograms: 154 lb ÷ 2.2 = 70 kg. The daily dose is 2.5 mg/kg/d, and 2.5 × 70 = 175 mg. The drug is available in 50mg tablets, and 175 mg ÷ 50 mg/tablet = 3.5 tablets.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 712, Androgens: Adverse Effects 15. The nurse attributes what assessment finding to the use of androgens by the male client?

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A) testicular atrophy B) increased fertility C) increased urination D) hoarseness

Ans: A

Feedback: In adult men, adverse effects include inhibition of testicular function, gynecomastia, testicular atrophy, priapism, baldness, and change in libido. Increased fertility, increased urination, and hoarseness would not be expected assessment findings.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 711, Table 41.1 16. The nurse has administered a prescribed dose of danazol to an adult female client for the purpose of preventing ovulation. When providing care related to the client’s underlying diagnosis, what nursing action is most appropriate? A) Monitor the client for signs and symptoms of infection. B) Provide a high-protein diet, unless contraindicated. C) Assess the client’s pain frequently. D) Encourage deep breathing and coughing exercises.

Ans: C Feedback: Danazol may be used in women to prevent or treat endometriosis, a health problem that is associated with chronic pain. For this reason, vigilant pain assessment would be a priority nursing action. There is no reason to believe that the client would be

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at particular risk for infection respiratory complications. There is no indication for a highprotein diet.

Format: Multiple Selection Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 712, Androgens: Adverse Effects 17. The nurse assesses the young adult athlete who has been taking anabolic steroids to enhance performance. The nurse should caution the client about what potential effects of this practice? Select all that apply. A) personality changes B) sexual dysfunction C) increased serum lipid levels D) cardiomyopathy E) weight loss

Ans: A, B, C, D

Feedback: Cardiomyopathy, hepatic carcinoma, personality changes, and sexual dysfunction are all associated with the excessive and off-label use of anabolic steroids for athletic performance enhancement. Adverse effects associated with prescription use include inhibition of testicular function, gynecomastia, testicular atrophy, priapism, baldness, change in libido, serum electrolyte changes, liver dysfunction, insomnia, and weight gain, not weight loss. Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Difficult Integrated Process: Nursing Process Objective: 3, 4 Page and Header: 713, Androgens: Clinically Significant Drug–Drug Interactions 18. The nurse learns a client receiving a new prescription for oxandrolone takes a lipidlowering medication daily. What will the nurse tell the client about this drug interaction? A) Lipid-lowering drug becomes much less effective. B) Increased risk of oxandrolone toxicity with this combination of drugs. C) Increased risk of liver damage with this combination of drugs. D) Oxandrolone becomes less effective with this combination of drugs.

Ans: A

Feedback: Anabolic steroids may alter lipid metabolism and cause a lack of effectiveness for lipid-lowering agents. Lipid-lowering medications do not impact anabolic steroids, and there is no increased risk for toxicity of either drug.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 713, Focus on Herbal and Alternative Therapies, Box 41.3 19. An athlete has expressed a desire to take creatine supplements in an effort to enhance the stamina and overall performance. What caution should the nurse provide? A) Creatine can be hepatotoxic. B) Severe allergic reactions have been associated with the use of creatine. C) Avoid taking any over-the-counter medications concurrently. D) Creatine supplements have been declared schedule 2 drugs because of their abuse potential.

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Ans: C

Feedback: Creatine interacts with many other drugs, including nonsteroidal antiinflammatory drugs, cimetidine, probenecid, and trimethoprim, and can cause serious effects on kidney functioning. For this reason, caution should be exercised around the use of OTC medications. It is not hepatotoxic nor is it a schedule 2 drug. Serious allergic reactions have not been reported.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 3 Page and Header: 711, Drugs in Focus: Androgens, Table 41.1 20. When a 5-year-old client is prescribed oxandrolone to promote weight gain, how would the nurse expect the drug to be administered? A) long-term B) short-term C) continuous D) intermittent Ans: D

Feedback: Oxandrolone is given intermittently to pediatric clients and should not be used on a daily basis for short, long, or continuous therapy.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 712, Androgens: Contraindications and Cautions 21. The nurse gives a class at the local high school on the use of anabolic steroids. The nurse should warn the students about what consequence of illicit use of steroids? A) kidney stones B) liver disease C) chronic diarrhea D) malignant hyperthermia

Ans: B

Feedback: Anabolic steroids carry a significant risk of liver toxicity. Kidney stones, chronic diarrhea, and malignant hyperthermia are not associated with the use of anabolic steroids.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 710, Androgens: Therapeutic Actions and Indications 22. When fluoxymesterone is administered to a 14-year-old male client for hypogonadism, what result will the nurse expect? A) enlarged sex organs B) decreased skin thickness C) increased protein metabolism D) increased sperm production

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Ans: A

Feedback: In prepubertal male clients, administration of male sex hormone–like drugs will stimulate development of masculine characteristics and cause development of the male sexual organs. Production of sperm will occur when the boy enters puberty. These drugs are not administered to decrease skin thickness or increase protein metabolism.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 711, Focus on Drug Therapy across the Lifespan: Older Adult, Box 41.1 23. A 69-year-old male client is prescribed testosterone. The client is found to have hypertension and a history of congestive failure after assessment by the nurse. What condition is this client at increased risk for? A) fluid retention B) impotence C) liver failure D) kidney failure

Ans: A

Feedback: Older adults often have hypertension and other cardiovascular disorders that may be aggravated by sodium and water retention associated with androgens and anabolic steroids. Testosterone would not increase the risk of impotence. Liver and kidney failure could be exacerbated by the drug if they were preexisting conditions but

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since that is not indicated by the question, this would be a lower risk than fluid retention.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 712, Androgens: Adverse Effects 24. The nurse is caring for a 28-year-old client who has been diagnosed with cryptorchidism. The client is taking testosterone to treat his condition. What statement by this client would lead the nurse to believe that the client has understood the teaching provided about the drug? A) “My amount of body hair may increase.” B) “My sexual desire may increase.” C) “My voice may become higher.” D) “My skin may become clear and soft.”

Ans: A

Feedback: Androgenic effects include acne, edema, hirsutism (increased hair distribution), deepening of the voice, oily skin and hair, weight gain, decrease in breast size, and testicular atrophy. Testosterone does not make the skin clear and soft; it does not make the voice higher, and the testicular atrophy is more likely to decrease rather than increase libido.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 710, Androgens: Therapeutic Actions and Indications 25. A 16-year-old male client is diagnosed with delayed onset of puberty and has been ordered testosterone, intramuscular (IM), once every 2 weeks. What nursing intervention would be important to the client? A) Discuss changes that will occur in his body. B) Have client fast before injection. C) Have client reduce protein intake. D) Decrease exercise while on this hormonal treatment.

Ans: A

Feedback: It is important for this client to understand what will happen and the changes the client will see to reduce the anxiety that could occur if the client didn’t understand. Discuss the development of masculine characteristics as well as common adverse effects such as acne. Having the client fast before the injection would not be necessary, nor would decreasing exercise or reducing protein intake.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 718, Drugs for Treating Penile Erectile Dysfunction: Pharmacokinetics 26. A client has been prescribed sildenafil. What should the nurse teach the client about this medication? A) Take the medication with a glass of grapefruit juice to potentiate effects.

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B) The drug should be taken 1 hour before attempting intercourse. C) Facial flushing or headache should be reported to the physician immediately. D) One to two percent of men experience hypersensitivity to their first dose.

Ans: B

Feedback: The drug should be taken approximately 1 hour before intercourse to allow adequate time for absorption and therapeutic effects to occur. Facial flushing, mild headache, indigestion, and running nose are common side effects of sildenafil citrate and do not need to be reported unless they become acute. Grapefruit juice should be avoided 2 days before until 2 days after taking the medication because it prolongs the drugs metabolism and excretion. The drug is not noted to have a high incidence of hypersensitivity.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 718, Drugs for Treating Penile Erectile Dysfunction: Contraindications and Cautions 27. A 55-year-old male client presents at the clinic reporting erectile dysfunction. The client has a history of diabetes mellitus. The primary health care provider orders tadalafil to be taken 1 hour before sexual intercourse. The nurse reviews the client’s history before instructing the client on the use of this medication. What disorder would contraindicate the use of tadalafil? A) cataracts B) penile implant C) hypotension D) lung cancer

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Ans: B

Feedback: Clients with a penile implant should not take tadalafil. Clients with cataracts, hypotension, or lung cancer may take tadalafil if needed but should do so with caution and should be carefully monitored for adverse effects.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 718, Drugs for Treating Penile Erectile Dysfunction: Contraindications and Cautions 28. For what reason might the nurse administer sildenafil to a female client? A) pulmonary arterial hypertension B) sexual dysfunction C) breast cancer D) endometriosis

Ans: A

Feedback: Sildenafil is used to treat erectile dysfunction in the presence of sexual stimulation in men and to treat pulmonary arterial hypertension in women. It is not used for sexual dysfunction, breast cancer, or endometriosis in women.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 718, Drugs for Treating Penile Erectile Dysfunction: Prototype Summary: Sildenafil 29. A 68-year-old male client tells the nurse, “I have been unable to maintain an erection for the past 6 months, and I guess my sex life is over.” The primary health care provider orders diagnostic testing to determine whether sildenafil is appropriate for the client. What is the most appropriate nursing conclusion for this client? A) sexual dysfunction B) disturbed body image C) ineffective sexuality pattern D) disturbed tactile sensory perception

Ans: A

Feedback: The client is experiencing sexual dysfunction so that would be the most appropriate nursing diagnosis. The client did not discuss feeling let down by or unhappy with his body, so disturbed body image is incorrect. The effectiveness of sexual pattern is not known. No problem with sensory perception is indicated by this question.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 717, Drugs for Treating Penile Erectile Dysfunction: Therapeutic Actions and Indications

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30. A 22-year-old male client asks the nurse, “I don’t have trouble obtaining and maintaining an erection but would sildenafil improve my sexual experience anyway?” What is the nurse’s best response? A) “The only thing sildenafil does is improve blood flow to the penis to make it erect.” B) “Sildenafil improves stamina and sensation, making the sexual experience better.” C) “Sildenafil has its greatest effect if both the man and woman take it at the same time.” D) “The medication sildenafil does nothing to improve the overall sexual experience.” Ans: A

Feedback: Sildenafil improves blood flow into the penis and that is its only effect. It does not improve stamina or sensation. Research has indicated that it has no effect on women’s sexual response. To say only that sildenafil does nothing would not provide adequate information for the client.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 711, Table 41.1 31. The client is prescribed oxandrolone 2.5 mg twice a day and is told to increase the dosage to gain weight to a maximum of 20 mg/d. If each tablet contains 2.5 mg, how many tablets would the nurse tell the client may be taken per day to avoid exceeding the 20 mg/d maximum? A) 4 B) 6 C) 8 D) 10

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Ans: C

Feedback: Calculate the number of tablets required to administer 20 mg by dividing 20 mg by 2.5 mg. 20/2.5 = 8 tablets.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 717, Drugs in Focus: Drugs Used to Treat Penile Erectile Dysfunction, Table 41.2 32. The male client is prescribed sildenafil 25 mg PO 1 hour before sexual intercourse is planned. The client returns for follow-up care and says that 25 mg did not produce an erection so the client increased the dosage. How much of an increase would concern the nurse? A) over 50 mg B) over 75 mg C) over 100 mg D) over 25 mg

Ans: C

Feedback: Normal dosage range is 25 to 100 mg so the nurse should not be concerned unless the dosage exceeded 100 mg.

Format: Multiple Choice Chapter: 41 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 713, Focus on Herbal and Alternative Therapies, Box 41.3 33. What information should the nurse provide to a client who has been prescribed testosterone and wants to begin taking the herb wild yam to increase energy production? A) “Rather than wild yam, I recommend you consider taking the supplement spirulina instead.” B) “It is best that you avoid the use of any herbal remedies in order to avoid adverse effects.” C) “There is substantial research evidence to support the effectiveness of wild yam on energy production.” D) “Creatine is found naturally in muscles and red meat; that’s a much better option for you.”

Ans: B

Feedback: Clients who are taking a prescribed androgen or anabolic steroid for a medical condition should be advised to avoid taking any of these herbal remedies because of the risk of adverse effects related to allergies, risk for kidney and/or liver damage, and effect on vitamin B12 absorption. Therefore, the nurse would not recommend another supplement such as spirulina or creatine. There is little evidence to support the effectiveness of any herbal therapy on performance or energy production.

Test Generator Questions, Chapter 42, Introduction to the Cardiovascular System Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation

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Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 726, Structure and Function of the Heart 1. Which structure should the nurse identify as separating the client’s right half of the heart from the left? A) auricle B) bundle of His C) syncytia D) septum

Ans: D

Feedback: The septum is a partition that separates the right and left halves of the heart. The right half receives deoxygenated blood from everywhere in the body and the left half receives oxygenated blood from the lungs. The auricle is an appendage attached to each atrium, which collects blood that is pumped into the ventricles by atrial contractions. Impulses are sent from the atria into the ventricles by way of the bundle of His, which then enters the septum and subdivides into three bundle branches that become a network of fibers that delivers the electrical impulse to the ventricular cells. The myocardium forms two intertwining networks, atrial and ventricular syncytia, which enable first the atria and then the ventricles to contract synchronously when excited by the same stimulus.

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2. A nurse is caring for a neonate born with a congenital heart anomaly. To better help the parents understand the impact of this disorder, the nurse begins by describing the usual flow of blood through the heart. What course should the nurse describe? A) Deoxygenated blood from the lungs enters the left atrium through the pulmonary artery. B) Oxygenated blood from the lungs enters the right atrium through the pulmonary veins. C) Deoxygenated blood from the lungs enters the right atrium through pulmonary veins. D) Oxygenated blood from the lungs enters the left atrium through the pulmonary veins.

Ans: D

Feedback: Oxygenated blood from the lungs enters the left atrium through the pulmonary veins and passes through the mitral valve into the left ventricle, which contracts and ejects blood through the aortic valve into the aorta and out to the systemic circulation.

Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 727, Structure and Function of the Heart: Cardiac Conduction 3. A client is scheduled to have a pacemaker implanted. The nurse knows this intervention will compensate for what cardiac deficit? A) increased preload B) increased afterload C) dysfunction of the SA node D) absence of sarcomeres

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Ans: C

Feedback: Pacemaker cells are found in the SA node of the heart, which controls cardiac contraction and relaxation, therefore controlling the overall heart rate. If the SA node malfunctions, a pacemaker would be indicated. Preload and afterload are variables that affect cardiac output, but they do not directly influence cardiac conduction. Sarcomeres are the functional units of cardiac muscles; it is not possible for a client to have an absence of sarcomeres.

Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 727, Structure and Function of the Heart: Automaticity 4. The nurse is describing some of the key characteristics of cardiac cells to a client. What action does the nurse use to explain cardiac cells’ performance? A) Synthesize a small amount of glucose in order to prolong their survival. B) Survive in an ischemic state for four to six times longer than skeletal muscle cells. C) Spontaneously generate an action potential. D) Produce neurotransmitters that stimulate electrical impulses independent of external stimulation.

Ans: C

Feedback: All cardiac cells possess some degree of automaticity, in which they can generate action potentials or electrical impulses without being excited to do so by external stimuli. This does not involve neurotransmitters. Cardiac cells cannot survive far longer than skeletal muscle without oxygen. Cardiac cells do not independently synthesize glucose.

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Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 736, Circulation: Heart Failure 5. A client has developed left-sided heart failure. What assessment finding should the nurse attribute to this health problem? A) increased abdominal girth B) irregular heart rhythm C) pitting edema to the ankles and feet D) shortness of breath

Ans: D Feedback: Pulmonary edema can occur when the heart is damaged and the left side of the heart is unable to effectively pump blood returning from the right side of the heart into systemic circulation. Accumulation of fluid in the lungs can cause shortness of breath. Right-sided failure is more closely associated with peripheral edema. Heart failure does not directly cause arrhythmias. Increased abdominal girth is more closely associated with fluid imbalances.

Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 2

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Page and Header: 736, Circulation: Heart Failure 6. A client, diagnosed with heart failure, would like the nurse to explain what the diagnosis means. How should the nurse explain heart failure? A) The heart muscle cannot pump as effectively as normal, causing a backup of blood. B) The hydrostatic pressure pushing fluid out of the capillaries is lower than the oncotic pressure. C) The decrease in venous pressure from the backup of blood increases hydrostatic pressure. D) Increased protein leads to reduced oncotic pressure and inability to pull fluid into the system.

Ans: A

Feedback: Heart failure occurs when the heart muscle fails to do its job of effectively pumping blood through the system and blood backs up and the system becomes congested. The rise in venous pressure that results from the backup of blood increases hydrostatic pressure on the venous end of the capillaries. The hydrostatic pressure pushing fluid out of the capillaries becomes greater than the oncotic pressure that is trying to pull the fluid back into the vessel, thus causing fluid to be lost into the body tissues. Protein loss can lead to a fall in oncotic pressure and an inability to pull fluid back into the vascular system.

Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 728, Structure and Function of the Heart: Autonomic Influences

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7. A client who is on a ventilator has been declared brain dead. A family member asks the nurse how the heart can still function if the client’s brain is dead. What statement is an appropriate response by the nurse? A) “Death of the heart will follow brain death in a few hours.” B) “The heart is controlled by the brainstem, not the upper levels of the brain.” C) “The cardiovascular center in the medulla is not be reflected in any tests.” D) “The heart is self-controlled and does not depend on the brain to beat.”

Ans: D

Feedback: The heart can generate action potentials on its own and can function without connection to the rest of the body. The heart will continue to function as long as oxygen and glucose are supplied to it. The brain does not initiate heart functioning. The cardiovascular center in the medulla helps to regulate blood pressure, not heart function.

Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 735, Circulation: Humoral Mechanisms of Blood Pressure Control 8. The nurse is caring for a client with traumatic injuries who is hypotensive. What pathophysiologic change could be the cause of the client’s health problem? A) activation of the renin–angiotensin–aldosterone system B) insufficient antidiuretic hormone (ADH) C) deficient natriuretic peptides D) increased tissue oxygen demand

Ans: B

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Feedback: Antidiuretic hormone is released from the pituitary gland resulting from reduced plasma volume or increased plasma osmotic pressure, so it serves to help maintain blood pressure. Low levels of natriuretic peptides would be more likely to cause hypertension as would activation of the renin–angiotensin–aldosterone system. Increased oxygen demand does not lead directly to hypotension.

Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 734, Circulation: Coronary Circulation 9. The nurse is caring for a client whose blood pressure is 120/78 mmHg. What would the nurse document as the client’s pulse pressure? A) 120 mmHg B) 99 mmHg C) 42 mmHg D) 198 mmHg

Ans: C

Feedback: The pulse pressure is the difference between systolic and diastolic pressure. The systolic pressure is usually 40 points greater than the diastolic pressure. A pulse pressure of over 50 points or less than 30 points is considered abnormal. This client’s pulse pressure is 42 mmHg (120 minus 78).

Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation

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Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 731, Electrocardiography: Ventricular Arrhythmias 10. A client is admitted to the cardiac unit with a diagnosis of a myocardial infarction (MI). The nurse notes that the client is having regular premature ventricular contractions (PVCs). What would concern the nurse? A) Blood is not efficiently pumped from the heart with PVCs. B) Healing of the myocardium will be disrupted. C) PVCs usually cause severe pain. D) PVCs make it difficult to make a definitive diagnosis.

Ans: A Feedback: Arrhythmias can alter cardiac output that could affect every cell in the body. Arrhythmias usually do not cause pain, disrupt healing, or interfere with the diagnosis of an MI.

Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 726, Structure and Function of the Heart: Cardiac Cycle 11. The nurse is caring for a client who is experiencing a backflow of blood from the left ventricle to the left atrium. How should the nurse best interpret this finding? A) The client’s mitral valve is incompetent. B) The client is likely having premature ventricular contractions (PVCs). C) The client has increased preload. D) There is a deficit involving the tricuspid valve.

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Ans: A

Feedback: The valve between the atrium and ventricle on the left side of the heart, called the mitral or bicuspid valve, is composed of two leaflets or cusps that allow the left ventricle to fill with blood and then close to prevent backflow of blood into the left atrium. If this valve is damaged, contraction of the ventricle will push blood back into the left atrium and result in inadequate cardiac output. The tricuspid valve is the valve between the right atria and ventricle. PVCs are a conduction problem that would not cause backflow of blood. Increased preload means the heart must work harder to move a larger volume of blood, but this would not cause regurgitation in the absence of a valve defect.

Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 734, Circulation: Coronary Circulation 12. A client’s blood pressure is 161/106 mmHg. How would the nurse explain how this blood pressure will affect the client’s cardiac workload? A) Increased systolic pressure will increase the client’s heart rate. B) The increased blood pressure causes an increase in preload and cardiac workload. C) Increased afterload creates increased oxygen consumption. D) The heart will have to pump harder to overcome the mitral and tricuspid valves.

Ans: C

Feedback: Increased blood pressure increases afterload and the overall workload of the heart. Hypertension does not increase preload, which is the volume of blood needing to

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be pumped. Similarly, hypertension does not make it more difficult to open the mitral and tricuspid valves between the atria and ventricles.

Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 727, Structure and Function of the Heart: Automaticity 13. The nurse takes the client’s pulse and finds a regular rate at 44 beats/min. What area of the heart is controlling this client’s heart rate? A) the atrioventricular (AV) node B) the bundle of His C) the Purkinje fibers D) the sinoatrial (SA) node

Ans: D

Feedback: The SA node generates an impulse about 90 to 100 times a minute, the AV node about 40 to 50 times a minute, and the complex ventricular muscle cells only about 10 to 20 times a minute.

Format: Multiple Selection Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 2

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Page and Header: 734, Circulation: Coronary Circulation 14. The nurse is caring for a client who has been diagnosed with severe coronary artery disease (CAD) and is experiencing chest pain. What forces could potentially be lowered to reduce oxygen consumption? Select all that apply. A) pulse pressure B) afterload C) stretch on the ventricles D) heart rate E) preload

Ans: B, C, D, E Feedback: The primary forces that determine the heart’s use of oxygen or oxygen consumption include heart rate (the more the heart has to pump, the more oxygen it requires), preload (the more blood that is returned to the heart, the harder it will have to work to pump the blood around), afterload (the higher the resistance in the system, the harder the heart will have to contract to force open the valves and pump the blood along), and stretch on the ventricles (if the ventricular muscle is stretched before it is stimulated to contract, more actomyosin bridges will be formed, which will take more energy). Pulse pressure does not impact oxygen consumption, though lowering blood pressure reduces afterload.

Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 736, Circulation: Heart Failure 15. The client has bilateral ankle edema resulting from heart failure (HF). The nurse interprets this as indicating what likely cause? A) The client’s pulse pressure is less than 30 mmHg.

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B) The oxygen demand of the client’s heart exceeds oxygen supply. C) Fluid pressure is forcing plasma in the client’s interstitial space. D) Hydrostatic pressure is exceeding oncotic pressure.

Ans: D

Feedback: Edema occurs when hydrostatic pressure pushing fluid out of the capillary exceeds the oncotic pressure that is trying to pull the fluid back into the vessel. This shift of fluid accounts for the edema seen in association with HF. Variations in pulse pressure do not cause edema, nor do variations in oxygen supply. “Fluid pressure” does not exist.

Format: Multiple Selection Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 735, Circulation: Hypertension 16. The nurse is providing health education to a client who has been newly diagnosed with hypertension. When explaining the need for vigilant blood pressure control, the nurse should describe what potential consequence of hypertension? Select all that apply. A) risk for damage to vessel walls B) heart valve failure C) arrhythmias D) increased cardiac workload E) impaired coronary circulation

Ans: A, D

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Feedback: Hypertension creates a risk for damage to delicate vessel walls and increased cardiac workload. It does not normally lead to valve failure, conduction problems, or disruptions to coronary circulation.

Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 731, Electrocardiography: Arrhythmias 17. The nurse is caring for an older adult client who is displaying alterations in the conduction of impulses in the SA node. What assessment finding is most likely? A) cardiac gallop B) tachycardia C) dysrhythmia D) heart murmur

Ans: C

Feedback: Alterations in the generation of conduction of impulses in the heart cause arrhythmias (dysrhythmias), which can upset the normal balance in the cardiovascular system and lead to a decrease in cardiac output, affecting all of the cells of the body. Tachycardia is only one of the possible arrhythmias that may result. Cardiac gallop and murmurs in the older adult with no history of congenital anomalies are usually caused by a poorly functioning heart valve and not by an alteration in conduction.

Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation

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Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 733, Circulation: Systemic Circulation 18. The nurse is caring for a client who has been diagnosed with coronary artery disease (CAD) and hypertension. The nurse explains to the client that CAD disables what process that controls blood pressure? A) capacitance system B) ability of the arterioles to increase or decrease resistance C) oncotic pressure D) ability of the venules to return blood to the veins

Ans: B

Feedback: The entire arterial system contains muscles in the walls of the vessels all the way to the terminal branches or arterioles, which consist of fragments of muscle and endothelial cells. These muscles offer resistance to the blood that is sent pumping into the arterial system by the left ventricle, generating pressure. The arterial system is referred to as a resistance system. Its vessels can either constrict or dilate, thus increasing or decreasing resistance, respectively, based on the needs of the body. The capacitance system is the venous system and does not contribute to regulation of arterial blood pressure. Oncotic pressure acts to pull the fluid back into the vessel. The venules have no impact on regulation of arterial blood pressure.

Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 2

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Page and Header: 726, Structure and Function of the Heart: Cardiac Cycle 19. The nurse is explaining cardiac function to a client. What will the nurse indicate is a necessary property for the muscle to function efficiently when it is acting as a pump? A) antagonistic contraction B) antagonistic relaxation C) simultaneous contraction D) simultaneous relaxation

Ans: C

Feedback: Simultaneous contraction is a necessary property for a muscle that acts as a pump. A hollow pumping mechanism must also pause long enough in the pumping cycle to allow the chambers to fill with fluid. The heart muscle relaxes long enough to ensure adequate filling; the more completely it fills, the stronger the subsequent contraction is. This occurs because the muscle fibers of the heart, stretched by the increased volume of blood that has returned to them, spring back to normal size. This property is defined through Starling’s law of the heart. Simultaneous relaxation or antagonistic contraction or relaxation is not necessary.

Format: Drag and Drop Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 726, Structure and Function of the Heart: Cardiac Cycle 20. The nurse is providing care for a client with a recent cardiac diagnosis and is explaining the structure and function of the heart. Place the events of circulation in the correct sequence, beginning with the entry of blood into the right atrium. Use each item once. A) Oxygenated blood enters the left atrium.

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B) Blood passes through the tricuspid valve. C) Blood is pumped from the right ventricle to the lungs. D) Blood passes through the mitral valve. E) Deoxygenated blood returns to the heart from the venous system. F) Oxygenated blood is pumped into circulation.

Ans: E, B, C, A, D, F

Feedback: Deoxygenated blood enters the right atrium, passing through the tricuspid valve to the right ventricle that pumps the blood to the lungs. After being oxygenated, it returns to the left atrium and passes through the mitral valve before being pumped into circulation by the left ventricle.

Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 727, Structure and Function of the Heart: Automaticity 21. The nurse explains to a client that when sodium gates open along the cardiac cell membrane and sodium rushes into the cell, it results in the membrane no longer having a positive or negative side but being electrically the same on both sides. How does the nurse describe this period of the cardiac cycle to the client? A) depolarization B) repolarization C) polarity D) action potential

Ans: A

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Feedback: Phase 0 occurs when the cell reaches a point of stimulation. The sodium gates open along the cell membrane, and sodium rushes into the cell, resulting in a positive flow of electrons into the cell—an electrical potential. This is called depolarization. The membrane no longer has a positive side or pole and a negative side; instead, it is depolarized, or, in other words, electrically the same on both sides. During depolarization, the cells cannot be forced to contract. Repolarization is when the sodium returns to the outside of the cell and potassium returns to the inside of the cell and the muscle is ready to contract again. Action potential is the ability of the heart to respond to an electrical stimulus. Polarity is the electrical charge.

Format: Drag and Drop Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 727, Structure and Function of the Heart: Cardiac Conduction 22. The nurse explains the normal conduction pathway to a client who has been diagnosed with dysrhythmia. Place these parts of the heart in the current sequence of cardiac conduction. Use each option once. A) bundle of His B) AV node C) Purkinje fibers D) SA node

Ans: D, B, A, C

Feedback: The normal conduction route is SA node to AV node to bundle of His to Purkinje fibers.

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Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 726, Structure and Function of the Heart: Cardiac Cycle 23. The client has had a myocardial infarction. The nurse realizes the significance of this injury is damage to what layer of the heart? A) endocardium B) pericardium C) myocardium D) epicardium

Ans: C

Feedback: The fibers of the cardiac muscle, or myocardium, form two intertwining networks called the atrial and ventricular syncytia. A myocardial infarction impacts this layer, which results in reduced pumping ability. The endocardium is the inner lining of the heart that comes in contact with the blood. The pericardium is the sac around the heart. The epicardium is the outermost layer of the heart.

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24. The nurse is caring for a client with decreased blood flow to the kidneys. The client’s blood pressure has been in the range of 150/100 mmHg for several days. What is the most likely cause of this client’s hypertension? A) lack of antidiuretic hormone (ADH) B) vasodilation C) release of renin D) increased natriuretic peptide levels

Ans: C

Feedback: When blood flow to the kidneys is decreased, cells in the kidney release an enzyme called renin. Renin ultimately increases blood pressure and should increase blood flow to the kidneys to decrease the release of renin. Vasodilation, increased natriuretic peptide levels, and lack of ADH would lead to hypotension.

Format: Multiple Choice Chapter: 42 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 731, Electrocardiography: Ventricular Arrhythmias 25. The nurse is assigned to watch the cardiac monitors in the constant care unit and notes four different clients displaying arrhythmias. Which arrhythmia is the nurse’s highest priority? A) sinus bradycardia at a rate of 54 beats/min B) atrial flutter C) sinus tachycardia at a rate of 108 beats/min D) ventricular fibrillation

Ans: D

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Feedback: Ventricular fibrillation is seen as a bizarre, irregular, distorted wave. It is potentially fatal because it reflects a lack of any coordinated stimulation of the ventricles. The ventricles’ inability to contract in a coordinated fashion results in no blood being pumped to the body or the brain. Thus, cardiac output is totally lost. Sinus bradycardia, sinus tachycardia, and atrial flutter may all require attention but are not as life threatening as ventricular fibrillation.

Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 727, Structure and Function of the Heart: Automaticity 26. How does the nurse describe the cardiac action potential to a client? A) the cycle of depolarization and repolarization B) the time it takes from the firing of the sinoatrial (SA) node to the contraction of the ventricles C) the time between the contraction of the atria and the contraction of the ventricles D) the cycle of the firing of the atrioventricular (AV) node and the contraction of the myocardium

Ans: A

Feedback: The action potential of the cardiac muscle cell consists of five phases: Phase 0 occurs when the cell reaches a point of stimulation. This is called depolarization. Phase 2, or the plateau stage, is a process called repolarization. Phase 4 is when spontaneous depolarization begins again. The action potential involves electrolytes and polarization and does not involve timing of the cardiac cycle.

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Format: Multiple Selection Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 737, Circulation: Key Points 27. The nurse teaches a group of clients on the systems that control blood pressure. Which system will the nurse include in the discussion? Select all that apply. A) the capacitance system B) aldosterone–antidiuretic hormone (ADH) system C) difference between the systolic and the diastolic readings D) stimulus from the sympathetic system E) reflex control of blood volume

Ans: B, D, E

Feedback: Blood pressure is maintained by stimulus from the sympathetic system and reflex control of blood volume and pressure by the renin–angiotensin system and the aldosterone–ADH system. The difference between the systolic and the diastolic readings does nothing to control blood pressure. The capacitance system does not regulate blood pressure.

Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 2

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Page and Header: 734, Circulation: Coronary Circulation 28. The nurse explains how the myocardium receives oxygen to a client in the constant care unit. The nurse explains to the client that the coronary arteries receive blood when? A) during diastole B) during systole C) when the heart is refractory D) when the aortic valve is open

Ans: A

Feedback: The coronary arteries receive blood during diastole, when the muscle is at rest and relaxed so that blood can flow freely into the muscle. When the left ventricle contracts, it forces the aortic valve open, which in turn causes the leaflets of the valve to cover the openings of the coronary arteries.

Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1, 2 Page and Header: 726, Structure and Function of the Heart 29. A client asks the nurse to explain why the left ventricle is so much larger than the right ventricle. Which explanation will the nurse provide? A) “The left ventricle needs to pump blood through the entire body.” B) “The left ventricle needs to pump blood through both lungs.” C) “The right ventricle pumps blood through the entire body.” D) “The right ventricle pulls blood back into the heart from the lungs.”

Ans: A

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Feedback: The left ventricle is much larger because it has to pump strongly enough to circulate blood through the entire body. The right ventricle pumps blood only to the lungs, which are nearby.

Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 734, Circulation: Coronary Circulation 30. The nurse is caring for a client with hypertension and recognizes this will have what impact on afterload? A) increased afterload B) reduced afterload C) unchanged afterload D) initial increase and then decrease in afterload Ans: A

Feedback: Blood pressure is a measure of afterload so the higher the client’s blood pressure, the higher the afterload. The higher the resistance in the system, the harder the heart will have to contract to force open the valves and pump the blood along.

Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 4

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Page and Header: 734, Circulation: Coronary Circulation 31. The client’s blood pressure is low due to shock and vasodilation of the blood vessels. The nurse recognizes this will have what impact on preload? A) Preload will increase. B) Preload will decrease. C) Preload will depend on afterload. D) Preload will vary with activity of the client.

Ans: B

Feedback: Preload is the amount of blood brought back to the heart to be pumped through the body. Vasodilation and shock will reduce preload because the pressure in the system is reduced, pushing less fluid through the vessels.

Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 735, Circulation: Humoral Mechanisms of Blood Pressure Control 32. The client has an excessive production of antidiuretic hormone (ADH). The nurse expects what change in the client’s blood pressure? A) Increase in the blood volume which will then cause an increase in the blood pressure. B) Increase in water and sodium excretion which will then cause a decrease in the blood volume. C) Increase in ADH production which will then cause an increase in renin production and hypertension. D) Increase in ADH production which will then decrease angiotensin production and hypotension.

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Ans: A

Feedback: Release of ADH causes the kidney to retain water and increase blood volume. Increasing blood volume increases blood pressure.

Format: Multiple Choice Chapter: 42 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 733, Circulation: Systemic Circulation 33. A dysfunction of a client’s autonomic nervous system has resulted in the arterial resistance system performing inadequately. What assessment will the nurse perform to monitor the client’s condition? A) heart rate B) heart rhythm C) blood pressure D) level of consciousness

Ans: C

Feedback: The arterial system is referred to as a resistance system. The vessels can either constrict or dilate, respectively increasing or decreasing resistance, based on the needs of the body. The arterioles are able to completely shut off blood flow to some areas of the body; that is, they can shunt blood to another area where it is needed more. The arterioles, because of their ability to increase or decrease resistance in the system, are one of the main regulators of blood pressure. This makes monitoring blood pressure most important in this situation. Inadequate performance of the arterial resistance system does not directly affect a client’s heart rate or rhythm or the level of consciousness.

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Test Generator Questions, Chapter 43, Drugs Affecting Blood Pressure Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 746, Focus on Cultural Considerations: Antihypertensive Therapy, Box 43.3 1. The nurse is caring for a 39-year-old client of African descent who is 25 lb (11.36 kg) overweight and who has received a new diagnosis of hypertension. What initial drug therapy should the nurse anticipate? A) angiotensin-converting enzyme (ACE) inhibitor B) beta-blocker C) calcium channel blocker D) diuretic

Ans: D

Feedback: Clients of African descent are at highest risk for developing hypertension, with men being more likely than women to develop the disease. Clients of African descent have documented differences in response to antihypertensive therapy. They are most responsive to single-drug therapy and diuretics. The first-line use of a diuretic is in combination with diet and other lifestyle changes. The use of a calcium channel blocker and/or alpha-adrenergic blocker should follow. Clients of African descent are less responsive to ACE inhibitors and beta-blockers.

Format: Multiple Choice

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Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 753, Drugs Affecting the Renin–Angiotensin–Aldosterone System: Contraindications and Cautions 2. The clinic nurse assesses a client taking benazepril to control hypertension. What change in the client’s health status may require a change in drug therapy? A) The client takes a selective serotonin reuptake inhibitor (SSRI) for depression. B) The client is treated for hepatitis A. C) The client’s creatinine clearance is steadily declining. D) The client is diagnosed with gastroesophageal reflux disease.

Ans: C

Feedback: Benazepril is an angiotensin-converting enzyme inhibitor; drugs in this class are contraindicated in the presence of impaired renal function. Mental illness, hepatic disease, and GERD are not contraindications with this drug.

Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 756, Prototype Summary: Losartan 3. A client has been prescribed losartan for hypertension. What client teaching points should the nurse include about this drug?

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A) “You need to report the onset of a fever or persistent cough to your health care provider.” B) “Limit your fluid intake to decrease urinary output, if this becomes problematic for you.” C) “Monitor your blood pressure once a week and make sure to record the results.” D) “It is recommended you take this medication late in the day to prevent sleepiness.”

Ans: A

Feedback: Losartan is an angiotensin II receptor blocker that is associated with a cough, back pain, fever, muscle weakness, and upper respiratory tract infections, so the client should be taught to report a fever or cough to the health care provider. Fluid intake should be normal. The drug is best taken in the morning. Blood pressure should be monitored daily, especially when first starting the drug, when adverse effects are not yet known.

Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 755, Nursing Considerations for Patients Receiving AngiotensinConverting Enzyme Inhibitors: Intervention with Rationale 4. A client has been diagnosed with hypertension and prescribed ramipril. When planning this client’s care, what outcome should the nurse identify? A) a blood pressure of 110/70 mmHg or less B) close adherence to the prescribed regimen C) absence of any adverse effects of treatment D) resolution of peripheral edema

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Ans: B

Feedback: Regardless of what medication the client is prescribed, adherence to the regimen is a priority outcome. A blood pressure of 110/70 mmHg or less may not be realistic, or even desirable, for many clients. Most antihypertensives, including ACE inhibitors, do not address fluid volume excess and peripheral edema. Adverse effects should be anticipated and managed; it is unrealistic to expect a complete absence of adverse effects.

Format: Multiple Choice Chapter: 43 Client Needs: Health Promotion and Maintenance Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1, 5 Page and Header: 753, Stepped Care Management of Hypertension, Box 43.7 5. During a stepped-care management approach, when should the nurse teach about recommended changes in lifestyle to a client? A) step 1 only B) steps 1 and 2 C) steps 1, 2, and 3 D) steps 1, 2, 3, and 4

Ans: D

Feedback: Lifestyle changes are encouraged in all four steps and should be advocated for the maintenance of good health. These changes are stressed in steps 1 and 2 in the hope that drug therapy will not be necessary. However, these changes should occur in steps 3 and 4 as well.

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Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 758, Calcium-Channel Blockers: Prototype Summary: Diltiazem 6. A client taking diltiazem for hypertension has come to the clinic for a follow-up appointment. The nurse will assess the client for which adverse effects? A) chest pain and pale skin B) shortness of breath and wheezing C) peripheral edema and bradycardia D) tachycardia and anxiety

Ans: C

Feedback: Cardiovascular adverse effects of diltiazem include bradycardia, peripheral edema, and hypotension. Skin flushing and rash may occur. There should be no effect on the lungs, and anxiety is not expected.

Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 751, Focus on Drug Therapy Across the Lifespan: Drugs Affecting Blood Pressure: Adults, Box 43.6 7. A client who works in construction has been diagnosed with hypertension. After attempting to decrease the client’s blood pressure with lifestyle changes and a mild

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diuretic, it is determined that the client needs to begin taking an angiotensin-converting enzyme (ACE) inhibitor. In an effort to prevent adverse effects, the nurse should address what client-related variable? A) frequent constipation B) excessive sweating on the job C) consumption of three large meals a day D) drinking an alcoholic beverage each night

Ans: B

Feedback: A client taking an ACE inhibitor should be sure to maintain fluid intake, so excessive sweating on the job places the client at risk for a drop in fluid volume. Excessive sweating, vomiting, diarrhea, or dehydration need to be monitored and treated if they occur while taking an ACE inhibitor. Six smaller meals rather than three larger ones would be better and should be encouraged. However, this could be a problem with the client’s job. The best treatment for constipation would be to increase fluid and fiber, and one alcoholic beverage a night would be within reason when considering alcohol intake.

Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 755, Nursing Considerations for Patients Receiving AngiotensinConverting Enzyme Inhibitors; 756, Angiotensin II Receptor Blockers: Contraindications and Cautions 8. What is the nurse’s priority assessment question before administering an angiotensin II receptor blocker (ARB) to a female client? A) “Have you ever been pregnant?”

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B) “Do you have regular mammograms?” C) “When was your last menstrual period (LMP)?” D) “Have you ever been diagnosed with a sexually transmitted infection (STI)?”

Ans: C

Feedback: It would be important to know when the client’s LMP occurred and that the client was not pregnant. These drugs can cause fetal abnormalities and fetal death. The other questions are appropriate and would help the nurse plan care for the client; however, it would not be as important as assessing for the possibility of pregnancy before beginning of therapy. The nurse should teach the client the need to avoid pregnancy using a barrier contraceptive.

Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 758, Calcium-Channel Blockers: Clinically Important Drug–Food Interactions 9. A client taking a calcium channel blocker is seen in the clinic and receives a diagnosis of drug toxicity. When collecting the nursing history, consumption of what product would indicate the likely cause of this drug toxicity? A) one to two alcoholic drinks daily B) dairy products in the morning C) grapefruit juice with meals D) aged cheese several times a week

Ans: C

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Feedback: The calcium channel blockers are a class of drugs that interact with grapefruit juice. When grapefruit juice is present in the body, the concentrations of calcium channel blockers increase, sometimes to toxic levels. Advise clients to avoid drinking grapefruit juice taking a calcium channel blocker. If a client on a calcium channel blocker reports toxic effects, ask whether the client is drinking grapefruit juice. Use of alcohol could be important if the client was ingesting large amounts but that would not be the most likely cause of drug toxicity. Dairy and cheese should not cause any food–drug interaction.

Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 751, Focus on Drug Therapy Across the Lifespan: Drugs Affecting Blood Pressure: Older Adults, Box 43.6 10. An older adult client is taking a sustained-release antihypertensive drug. What is the nurse’s priority teaching point about this medication? A) “Take your blood pressure only at night so that it is most accurate.” B) “Swallow the drug whole; do not to cut, crush, or chew it.” C) “Take the drug before bedtime to reduce your risk of falling.” D) “Use over-the-counter (OTC) cold medications cautiously.”

Ans: B

Feedback: Sustained-release drugs cannot be cut, crushed, or chewed; it destroys the matrix system and allows absorption of the complete dose all at once. Older clients should be especially cautioned about sustained-release antihypertensives that cannot be cut, crushed, or chewed to avoid the potential for excessive dosing if these drugs are inappropriately cut. Many OTC drugs contain ingredients that increase blood pressure

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and so are not recommended for clients with hypertension. The client can take their blood pressure any time in the day, but it is usually recommended for the morning.

Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 748, Fixed-Combination Drugs for the Treatment of Hypertension, Box 43.4 11. A client with hypertension has been prescribed losartan. After 6 weeks of therapy, the primary health care provider decides the losartan alone is not controlling the client’s hypertension. What does the nurse anticipate will be added to the losartan regimen for better control of this client’s hypertension? A) candesartan B) hydrochlorothiazide C) olmesartan D) antidiuretic hormone (ADH)

Ans: B

Feedback: When losartan (angiotensin II receptor blocker [ARB]) therapy is started, maximal effects on blood pressure usually occur within 3 to 6 weeks. If losartan alone does not control blood pressure, a low dose of a diuretic may be added. A combination product of losartan and hydrochlorothiazide is available. Adding a second ARB such as candesartan or olmesartan would risk causing toxic adverse effects. ADH causes retention of water in the nephrons, which would further increase blood pressure.

Format: Multiple Choice

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Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 754, Drugs Affecting the Renin–Angiotensin–Aldosterone System: Adverse Effects 12. The nurse is providing drug teaching for a client who is prescribed enalapril. What drug-specific adverse effect will the nurse include in the drug teaching? A) sedation B) persistent cough C) diarrhea D) hepatic dysfunction

Ans: B

Feedback: ACE inhibitors like enalapril are generally well tolerated but cause an unrelenting cough, possibly related to adverse effects in the lungs, where the angiotensin-converting enzyme is inhibited, which may lead clients to discontinue the drug. Sedation, diarrhea, and hepatic dysfunction are not generally associated with ACE inhibitors.

Format: Multiple Choice Chapter: 43 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 753, Stepped Care Management of Hypertension, Box 43.7

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13. The nurse provides dietary teaching to a client with hypertension. The nurse determines the client has understood the information when the client selects what meal? A) hot dogs, baked beans, and coleslaw B) French fries, grilled hamburger, and diet cola C) grilled chicken, green salad with dressing, and baked apple D) bologna sandwich with mayonnaise and potato salad

Ans: C

Feedback: Chicken, salad, and fruit are all low in sodium. The other meal options all contain foods high in sodium (i.e., hot dogs, French fries, processed meats like bologna, and potato salad).

Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 756, Nursing Considerations for Patients Receiving Angiotensin II Receptor Blockers; 757, Renin Inhibitor 14. A client’s hypertension has not responded significantly to first-line therapies, so the primary health care provider has prescribed aliskiren and spironolactone. In addition to blood pressure monitoring, what assessment should the nurse prioritize? A) AST, ALT, and bilirubin levels B) serum potassium level C) quantity and character of urine output D) heart rhythm

Ans: B

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Feedback: Aliskiren can cause an increase in potassium levels because it prevents the stimulation of aldosterone. Spironolactone is a potassium-sparing diuretic, so it also creates a risk for hyperkalemia. Liver enzyme levels are unlikely to be affected, since there is no significant risk for hepatotoxicity. Urine output and heart rhythm are not normally affected.

Format: Multiple Selection Chapter: 43 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 741, Review of Blood Pressure Control 15. The nurse is discussing antihypertensive medications with a group of clients. Which element will the nurse identify as responsible for regulating the pressure in the cardiovascular system? Select all that apply. A) heart rate B) stroke volume C) preload D) total peripheral resistance E) pulse pressure

Ans: A, B, D

Feedback: The pressure in the cardiovascular system is determined by three elements: heart rate; stroke volume, or the amount of blood that is pumped out of the ventricle with each heartbeat (primarily determined by the volume of blood in the system); and total peripheral resistance, or the resistance of the muscular arteries to the blood being pumped through. The preload and the pulse pressure are not factors that regulate pressure in the cardiovascular system.

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Format: Drag and Drop Chapter: 43 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 742, Review of Blood Pressure Control: Renin–Angiotensin– Aldosterone System 16. A nurse is reviewing the function of the renin–angiotensin–aldosterone system before assessing a client with hypertension. Place these events in the function of the renin–angiotensin–aldosterone system in the order they occur. Use each option once. A) Renin is released by juxtaglomerular cells. B) Blood pressure increases due to vasoconstriction. C) Angiotensinogen is converted to angiotensin I. D) Low blood pressure is detected. E) Angiotensin II reacts with blood vessel receptors.

Ans: D, A, C, E, B

Feedback: Low blood pressure or poor oxygenation of a nephron causes the release of renin from the juxtaglomerular cells, a group of cells that monitor blood pressure and flow into the glomerulus. Renin is released into the bloodstream and arrives in the liver to convert the compound angiotensinogen (produced in the liver) to angiotensin I. Angiotensin I travels in the bloodstream to the lungs, where the metabolic cells of the alveoli use angiotensin-converting enzyme (ACE) to convert angiotensin I to angiotensin II. Angiotensin II reacts with specific angiotensin II receptor sites on blood vessels to cause intense vasoconstriction.

Format: Multiple Selection Chapter: 43

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Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 742, Review of Blood Pressure Control: Hypertension 17. The nurse is caring for a client who has been nonadherent with treatment for hypertension. The nurse explains untreated hypertension increases the risk of which complication? Select all that apply. A) renal disease B) cerebral infarction C) heart failure D) cholecystitis E) migraine headache

Ans: A, B, C

Feedback: Hypertension is a common chronic disorder. Hypertension increases risks of myocardial infarction, heart failure, cerebral infarction and hemorrhage, and renal disease. It does not increase the risk of cholecystitis or migraine headache.

Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 748, Treatment of Pulmonary Arterial Hypertension, Box 43.5 18. The nurse administers ambrisentan to the client with pulmonary arterial hypertension. What assessment should the nurse prioritize in order to monitor the effectiveness of this medication?

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A) Assess the client’s oxygen saturation. B) Check the client’s blood pressure lying, sitting, and standing. C) Determine the client’s exercise tolerance. D) Auscultate the client’s lungs.

Ans: C

Feedback: Although it is certainly important to assess all aspects of oxygenation and ventilation, the single best indicator of drug effectiveness in clients with pulmonary arterial hypertension is improved exercise tolerance. This drug is not given to treat systemic hypertension or orthostatic hypotension, so postural blood pressures are not necessary.

Format: Multiple Choice Chapter: 43 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 751, Focus on Drug Therapy Across the Lifespan: Drugs Affecting Blood Pressure: Children, Box 43.6 19. The pediatric nurse examines an 11-year-old client with mildly elevated blood pressure who is 15% above the upper age-based weight limits. What is the nurse’s priority teaching point? A) Help the client and family find way to increase the client’s activity level. B) Explain how to properly administer diuretics to the client. C) Establish firm limits around the client’s food intake. D) Explain the most common adverse effects of calcium channel blockers.

Ans: A

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Feedback: Treatment of childhood hypertension should be done very cautiously because the long-term effects of the antihypertensive agents are not known. Lifestyle changes should be instituted before drug therapy is started if at all possible. This should be done using a collaborative approach that includes the family. Weight loss and increased activity may bring an elevated blood pressure back to normal in many children. As a result, the priority teaching point is to help parents understand how to adapt the child’s diet to reduce weight and introduce family activities to increase exercise. A prescriptive approach to diet is likely to be perceived as punitive, possibly reducing adherence and self-esteem. Drug teaching would only be required if lifestyle changes is inadequate to lower blood pressure.

Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 751, Focus on Drug Therapy Across the Lifespan: Drugs Affecting Blood Pressure: Children, Box 43.6 20. The nurse is caring for a child who is obese, has hypertension, and has a slightly elevated serum glucose level. Which medication would the nurse anticipate the primary health care provider will prescribe the client if lifestyle changes do not return blood pressure to an acceptable limit? A) angiotensin-converting enzyme (ACE) inhibitor B) diuretic C) calcium channel blocker D) beta-adrenergic blocker

Ans: B

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Feedback: Lifestyle changes should be instituted before drug therapy if at all possible. If drug therapy is used, a mild diuretic may be tried first, with monitoring of blood glucose and electrolyte levels on a regular basis. Calcium channel blockers have been used to treat hypertension in children and may be among the first considerations if drug therapy other than mild diuretics is needed. Beta-blockers have been used with success in some children; adverse effects may limit their usefulness in others. The safety and efficacy of the angiotensin-converting enzyme (ACE) inhibitors and the angiotensin receptor blockers (ARBs) have not been established in children.

Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 760, Vasodilators 21. The emergency department nurse is asked to prepare a nitroprusside infusion for a client being brought to the hospital in an ambulance. What is this client’s most likely diagnosis? A) hypertensive crisis B) myocardial infarction accompanied by hypertension C) hemorrhagic stroke D) hypertension associated with diabetic ketoacidosis

Ans: A

Feedback: Most of the vasodilators are reserved for use in severe hypertension or hypertensive emergencies. These include hydralazine, minoxidil, and nitroprusside. The presence or absence of a comorbidity such as stroke, diabetic ketoacidosis, or MI does not increase the likelihood of use.

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Format: Multiple Selection Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 755, Nursing Considerations for Patients Receiving AngiotensinConverting Enzyme Inhibitors: Evaluation; 756, Angiotensin II Receptor Blockers: Prototype Summary: Losartan 22. The nurse cares for a client who has been diagnosed with type 2 diabetes and uncontrolled hypertension and is prescribed losartan. The primary health care provider changes this client’s prescription to losartan with hydrochlorothiazide. What benefits should the nurse anticipate the client will receive from this change in drug therapy? Select all that apply. A) slowed progression of diabetic nephropathy B) increased excretion of fluid and sodium C) alteration of electrolyte and acid–base balance D) improved control of blood pressure E) fewer adverse medication-related effects

Ans: A, B, D

Feedback: Many clients require more than one type of antihypertensive to achieve good control of their blood pressure. There are now many fixed combination drugs available for treating hypertension. This allows for fewer tablets or capsules each day, making it easier for the client to comply with drug therapy. Losartan slows the progression of diabetic nephropathy in clients with hypertension and type 2 diabetes. Hydrochlorothiazide is a diuretic that will increase excretion of fluid and sodium resulting in a lower circulating blood volume that will help to reduce blood pressure, preload, and afterload. The two drugs will work together to better control the client’s blood pressure. Alteration in electrolytes and acid–base is a reasonable expectation, but it is an adverse

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effect and not a benefit. There are likely to be more adverse effects when taking drugs that are not fixed combinations.

Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 742, Review of Blood Pressure Control: Hypertension 23. The nurse would anticipate which client to most likely to be diagnosed with secondary hypertension? A) a client whose most recent blood pressure readings were 143/92, 147/94, and 144/94 mmHg B) a client with type 1 diabetes who has developed nephropathy C) a client whose body mass index is 31 D) a client who is being treated for pheochromocytoma

Ans: D

Feedback: The majority of clients with hypertension have the primary (essential) form, in which there is no obvious cause. A client with a pheochromocytoma would have secondary hypertension, because the cause is identifiable. Obesity and diabetes are associated with hypertension but are not the direct causes of it. A client with blood pressures of 143/92, 147/94, and 144/94 mmHg would be likely diagnosed with hypertension but not likely the secondary type.

Format: Multiple Selection Chapter: 43 Client Needs: Health Promotion and Maintenance

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Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 753, Stepped Care Management of Hypertension, Box 43.7 24. A client who has been diagnosed with hypertension asks the nurse if there are any treatment options other than medications available. What lifestyle changes should the nurse recommend to the client? Select all that apply. A) “Increase the amount of exercise that you do.” B) “Eliminate all salt from your diet.” C) “Reduce your overall intake of fluids.” D) “Lose some weight, if possible.” E) “Try meditation, if it’s something you’re interested in.”

Ans: A, D, E

Feedback: Exercising, losing weight, and meditation to reduce stress are all effective lifestyle changes the client can make. It is not necessary, or even possible, to eliminate all sodium from the diet, but cutting back will reduce water retention. Reducing intake of fluids is not a healthy option and would not be suggested unless comorbidities, such as possibility of heart failure, were present.

Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 742, Review of Blood Pressure Control: Hypertension 25. The nurse evaluates a client’s lifestyle for factors contributing to hypertension. Which lifestyle factor would the nurse addresses as a need to change?

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A) working outdoors in the sun B) weight lifting at the gym C) consuming a high-protein diet D) smoking outside of the home

Ans: D

Feedback: Factors that are known to increase blood pressure in some people include high levels of psychological stress, exposure to high-frequency noise, a high-salt diet, lack of rest, smoking, and genetic predisposition. Smoking indoors and outdoors are both risk factors. Working outdoors in the sun may increase risk for skin cancer but does not contribute to hypertension. Weight lifting is good exercise, especially if they use low weight and frequent repetition. High protein intake is not a contributing factor for hypertension.

Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 742, Review of Blood Pressure Control: Hypotension; 755, Nursing Considerations for Patients Receiving Angiotensin-Converting Enzyme Inhibitors 26. A client is admitted to the intensive care unit in shock with hypotension. What is an appropriate nursing conclusion for this client? A) impaired gas exchange B) deficient fluid volume C) risk for falls D) ineffective peripheral tissue perfusion

Ans: D

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Feedback: An appropriate nursing conclusion would be ineffective peripheral tissue perfusion. If blood pressure becomes too low, the vital centers in the brain, as well as the rest of the tissues of the body, may not receive enough oxygenated blood to continue functioning. The client’s risk for falls would be low because the client is acutely ill and confined to bed. There is no direct indication of altered gas exchange or deficient fluid volume.

Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 755, Drugs Affecting the Renin–Angiotensin–Aldosterone System: Angiotensin-Converting Enzyme Inhibitors: Nursing Considerations for Patients Receiving Angiotensin-Converting Enzyme Inhibitors: Nursing Conclusions 27. The nurse is caring for a client who takes ramipril to treat hypertension. The nurse would monitor the client for which potential complication? A) ineffective tissue perfusion B) acute headaches C) unrelenting cough D) impaired body image

Ans: A

Feedback: Complications related to drug therapy might include ineffective tissue perfusion (total body) related to changes in cardiac output because ramipril is associated with adverse effects such as reflex tachycardia, chest pain, angina, heart failure, and cardiac arrhythmias. Although dermatitis and rash may occur, headaches are not an associated adverse effect of this drug. Benazepril, enalapril, and fosinopril can cause an

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unrelenting cough, but ramipril is not associated with this adverse effect. Impaired body image would not be associated with this drug.

Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Page and Header: 757, Calcium Channel Blockers 28. What drug is a safe and effective calcium channel blocker only if the nurse administers it as a sustained-release or extended-release preparation to treat a client diagnosed with hypertension? A) aliskiren B) diltiazem C) atenolol D) metoprolol

Ans: B

Feedback: The calcium channel blockers available in immediate-release and sustainedrelease forms that are used in treating hypertension include amlodipine, felodipine, isradipine, and nicardipine. Other calcium channel blockers are safe and effective for this use only if they are given as sustained-release or extended-release preparations. These include diltiazem, nifedipine, nisoldipine, and verapamil. Aliskiren is a renin inhibitor. Atenolol and metoprolol are beta-blockers, not calcium channel blockers.

Format: Multiple Selection Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 746, Focus on Cultural Considerations: Antihypertensive Therapy, Box 43.3 29. The nurse works in a clinic with a high population of clients of African descent. What would the nurse need to consider when caring for clients with hypertension? Select all that apply. A) Male clients of African descent are the population at highest risk for developing hypertension. B) Research has shown that clients of African descent respond best to single-drug therapy. C) Clients of African descent are most responsive to angiotensin-converting enzyme inhibitors. D) Increased adverse effects occur when using thiazide and thiazidelike diuretics. E) First-line use of a calcium channel blocker with changes to lifestyle is best in clients of African descent.

Ans: A, B, D

Feedback: Clients of African descent are at highest risk for developing hypertension, with men more likely than women to develop the disease. Clients of African descent are most responsive to single-drug therapy (as opposed to combination drug regimens). Clients of African descent are less responsive to angiotensin-converting enzyme inhibitors and beta-blockers. Increased adverse effects (e.g., depression, fatigue, drowsiness) often occur when using thiazide and thiazidelike diuretics. Because clients of African descent are more responsive to diuretics, the treatment approach should include the first-line use of a diuretic in combination with diet and other lifestyle changes. Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 748, Treatment of Pulmonary Arterial Hypertension, Box 43.5 30. The nurse is caring for a client who has been newly prescribed bosentan for the treatment of pulmonary arterial hypertension. What is the nurse’s priority teaching point about this medication? A) “The dose may be increased after 4 weeks of treatment.” B) “This medication is given buccally.” C) “A rash is a common side effect and will disappear in a few days.” D) “You will take the medication twice daily.”

Ans: A

Feedback: Bosentan is an oral drug and is given to adults, initially as 62.5 mg PO twice a day for 4 weeks and then increased to 125 mg PO twice a day if the client’s exercise tolerance improves. It is not generally associated with the development of a rash.

Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 751, Focus on Drug Therapy Across the Lifespan: Drugs Affecting Blood Pressure: Adults, Box 43.6 31. The primary health care provider determines that the benefits of drug therapy outweigh the risks in a pregnant client who has been diagnosed with hypertension. What category of antihypertensive does the nurse expect to be prescribed for this client? A) angiotensin-converting enzyme (ACE) inhibitor B) angiotensin receptor blocker (ARB)

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C) renin inhibitor D) calcium channel blocker

Ans: D

Feedback: ACE inhibitors, ARBs, and renin inhibitors should not be used during pregnancy, and women of childbearing age should be advised to use barrier contraceptives to prevent pregnancy while taking these drugs. Calcium channel blockers and vasodilators can be used in pregnancy with caution if the benefit to the pregnant client clearly outweighs the potential risk to the fetus.

Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 753, Stepped Care Management of Hypertension, Box 43.7 32. A client was unable to achieve to manage hypertension with lifestyle changes or an angiotensin-converting enzyme inhibitor. Which medication will the nurse anticipate the primary health care provider will order next? A) diuretic B) beta-blocker C) calcium channel blocker D) vasodilator

Ans: A

Feedback: When lifestyle changes or an angiotensin-converting enzyme inhibitor are inadequate, another drug will be added for combined effect. However, fixed-combination drugs should only be used when the client has been stabilized on each drug separately.

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A diuretic would be added before adding another class of medication unless the first drug was a diuretic. Vasodilators are generally used only in hypertensive emergencies.

Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 758, Calcium-Channel Blockers: Prototype Summary: Diltiazem 33. The nurse is caring for a client who has been diagnosed with hypertension and is preparing to be discharged from the hospital after suffering a myocardial infarction. What drug would both treat the client’s hypertension and reduce myocardial oxygen consumption? A) captopril B) losartan C) diltiazem D) nitroprusside

Ans: C Feedback: Diltiazem inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells, depressing the impulse and leading to slowed conduction, decreased myocardial contractility, and dilation of arterioles, which lowers blood pressure and decreases myocardial oxygen consumption. Captopril, losartan, and nitroprusside do not have actions to reduce myocardial oxygen consumption.

Format: Multiple Choice Chapter: 43 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 754, Drugs Affecting the Renin–Angiotensin–Aldosterone System: Adverse Effects 34. A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor. What intervention should the nurse include in the plan of care to minimize the risk for injury related to adverse effects of this classification of medications? A) falls precautions B) low-fiber diet C) monitoring for orbital edema D) monitoring temperature of extremities

Ans: A

Feedback: The adverse effects most commonly associated with the ACE inhibitors are related to the effects of vasodilation and alterations in blood flow. Such effects include hypotension (BP needs to be monitored closely as medications are titrated), reflex tachycardia, chest pain, angina, heart failure, and cardiac arrhythmias; gastrointestinal (GI) irritation, ulcers, constipation, and liver injury; renal insufficiency, renal failure, and proteinuria; and rash, alopecia, dermatitis, and photosensitivity. Hypotension can result in dizziness and the accompanying risk for falls. A high-fiber diet would be appropriate to address constipation. Neither orbital edema nor poor circulation to extremities is associated with ACE inhibitor therapy.

Test Generator Questions, Chapter 44, Agents for Treating Heart Failure Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand

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Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 772, Heart Failure: Left-Sided Heart Failure 1. A client presents to the emergency department with rales, wheezing, and blood-tinged sputum. The nurse should select interventions to address what health problem? A) cardiomyopathy B) cardiomegaly C) valvular heart disease D) pulmonary edema

Ans: D

Feedback: In left-sided heart failure, the left ventricle pumps inefficiently resulting in a backup of blood into the lungs causing pulmonary vessel congestion and fluid leaks into the alveoli and lung tissue. As more fluid continues to collect in the alveoli, pulmonary edema develops. The client will present with rales, wheezes, blood-tinged sputum, low oxygenation, and development of a third heart sound. Cardiomyopathy can occur as a result of a viral infection, alcoholism, anabolic steroid abuse, or a collagen disorder. It causes muscle alterations and ineffective contraction and pumping. Cardiomegaly is an enlargement of the heart due to compensatory mechanisms in congestive heart failure (CHF) and leads to ineffective pumping and eventually exacerbated CHF. Valvular heart disease leads to an overload of the ventricles because the valves do not close adequately causing blood to leak backward. This causes muscle stretching and increased demand for oxygen and energy.

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 1 Page and Header: 771, Heart Failure: Fig. 44.1 2. Calcium has inactivated a client’s troponin, allowing actin and myosin to form a bridge. What effect will the nurse monitor for in this client? A) diastole to occur B) cardiac muscle fibers to contract C) a myocardial infarction (MI) D) cardiac output to decrease

Ans: B

Feedback: Calcium must be present to deactivate troponin so that actin and myosin can react to form actinomycin bridges. This results in muscle contraction, which would be associated with systole more than diastole. This phenomenon, occurring in many muscle fibers, would result in increased cardiac output. This is a normal physiological process, not a pathological process that would cause an MI.

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 775, Focus on Cultural Considerations: Drugs for Heart Failure, Box 44.1 3. A 62-year-old client of African descent who has been diagnosed with congestive heart failure and hypertension has isosorbide dinitrate and hydralazine included as drug therapy. What assessment should the nurse prioritize when monitoring for adverse effects of therapy? A) troponin levels B) liver enzyme levels

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C) level of consciousness D) positional blood pressures

Ans: D

Feedback: Orthostatic hypotension is an adverse effect of isosorbide dinitrate and hydralazine. The nurse can assess for this adverse effect by monitoring the client’s positional blood pressures. These are not noted to have effects on cognition or liver function. Troponin levels would rise with a myocardial infarction, which is not an adverse effect.

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 776, Focus on Drug Therapy Across the Lifespan: Agents to Treat HF: Children, Box 44.2 4. The nurse is preparing to administer digoxin to an infant. What is the nurse’s priority intervention for this client? A) performing hand hygiene B) confirming drug dosage calculations C) checking the client’s blood pressure D) educating the client’s parents about therapeutic effects

Ans: B

Feedback: The margin of safety for the dosage of this drug is very narrow in children. The dosage needs to be very carefully calculated and, in many institutions, must be double-checked by another nurse before administration. The nurse must know the

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client’s apical heart rate, but blood pressure is a lesser priority. Hand hygiene, as in all circumstances, is important, but the highest priority is a nontoxic dose of the drug. Similarly, education is important but is not as high a priority as ensuring a safe dose.

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 775, Cardiotonic Agents: Cardiac Glycosides: Therapeutic Actions and Indications 5. A client asks the nurse what cardiac glycosides do to relieve the symptoms of heart failure. What is the nurse’s best response? A) “They make your heart contract more forcefully.” B) “They increase your blood pressure by reducing your urine output.” C) “They increase your heart rate.” D) “They increase the velocity of the heart’s electrical conduction.”

Ans: A

Feedback: Cardiac glycosides increase intracellular calcium and allow more calcium to enter myocardial cells. This action causes an increased force of myocardial contraction, an increased cardiac output, and renal perfusion that increases urine output. Cardiac glycosides also serve to slow the heart rate and decrease conduction velocity.

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 777, Cardiotonic Agents: Cardiac Glycosides: Pharmacokinetics 6. What is the priority nursing assessment for a client who is about to begin digoxin therapy? A) blood glucose levels B) neurological function C) kidney function D) liver function

Ans: C

Feedback: Digoxin is primarily excreted unchanged in the urine, so caution should be exercised if renal impairment is present. Blood glucose levels and neurological and liver function would not be a priority assessment related to digoxin therapy.

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 778, Focus on The Evidence: Digoxin Toxicity and Nursing Considerations, Box 44.3 7. A nurse is assessing a 78-year-old client in the emergency department. The nurse determines the client is experiencing severe digoxin toxicity. What is the nurse’s priority action? A) Identify the client’s troponin levels. B) Administer digoxin immune fab as prescribed. C) Auscultate the client’s apical heart rate for a minimum of 90 seconds.

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D) Give intravenous acetylcysteine immediately.

Ans: B

Feedback: Digoxin immune fab is the antidote for digoxin toxicity and would be the priority intervention. The client’s troponin levels would not be available immediately and would not be a high priority. The client would be placed on cardiac monitoring, so manual auscultation of the apical heart rate would not be necessary. Acetylcysteine is the antidote for acetaminophen overdose and would not be beneficial.

Format: Multiple Choice Chapter: 44 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4, 5 Page and Header: 779, Cardiotonic Agents: Clinically Important Drug–Drug Interactions; 779, Focus on Herbal and Alternative Therapies: Box 44.4 8. The nurse is educating a client who has been prescribed digoxin. The nurse knows the client occasionally uses alternative therapies. What herb would the nurse inform the client to avoid taking with digoxin? A) black cohosh B) ginseng C) saw palmetto D) valerian

Ans: B

Feedback: Digoxin toxicity can occur if the drug is taken concurrently with licorice, ginseng, or hawthorn. St. John’s wort and psyllium have been shown to decrease the

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effectiveness of digoxin, so that combination should be avoided. There is no drug-todrug interaction with black cohosh, saw palmetto, or valerian.

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 783, Cardiotonic Agents: Phosphodiesterase Inhibitors: Clinically Important Drug–Drug Interactions 9. The nurse is preparing to administer milrinone to a client with heart failure. The nurse would perform adequate flushing before administering the medication in the same intravenous (IV) line as which other medication? A) albuterol B) nifedipine C) furosemide D) lovastatin

Ans: C

Feedback: Furosemide, when given with a phosphodiesterase inhibitor, forms precipitates; therefore, this combination should be avoided. Use alternate lines if both of these drugs are being given IV. There are no known drug-to-drug interactions with albuterol, nifedipine, or lovastatin.

Format: Fill-in-the-Blank Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 4, 6 Page and Header: 776, Drugs in Focus: HF Treatment Agents, Table 44.1 10. A 6-year-old client weighing 60 lb (27.27 kg) has been prescribed oral digoxin 30 mcg/kg as a loading dose. How many milligrams should the nurse administer? Round the answer to two decimal places.

Ans: 0.82 mg

Feedback: First, using the formula: amount of drug prescribed times weight in kilogram, determine the dose in microgram the child should receive (30 multiplied by 27.27 = 818.1 mcg). Then to determine the amount of milligram the child should receive, use the formula: 1 mg: 1,000 mcg = X mg: 818 mcg (818/1,000 = 0.818 mg). To two decimal places, this rounds to 0.82 mg.

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 6 Page and Header: 782, Cardiotonic Agents: Nursing Considerations for Patients Receiving Cardiac Glycosides: Intervention with Rationale 11. The nurse assesses a client before administering digoxin. What finding would cause the nurse to withhold the drug and notify the primary health care provider? A) respiratory rate of 13 breaths/min B) history revealing liver failure C) pulse 44 beats/min D) blood pressure 102/66 mmHg

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Ans: C

Feedback: Monitor apical pulse for one full minute before administering the drug to assess for adverse effects. Hold the dose if the pulse is less than 60 beats/min in an adult or less than 90 beats/min in an infant; retake pulse in 1 hour. If pulse remains low, document pulse, withhold the drug, and notify the prescriber. Moderate hypotension would not likely require withholding the drug.

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 4, 6 Page and Header: 782, Cardiotonic Agents: Nursing Considerations for Patients Receiving Cardiac Glycosides: Intervention with Rationale 12. A hospitalized client diagnosed with heart failure is prescribed digoxin. What should the nurse include in the client’s plan of care? A) Have mivacurium chloride readily available. B) Monitor the client’s heart rate daily. C) Ensure that the client has easy access to the bathroom. D) Administer with food to minimize gastrointestinal upset.

Ans: C

Feedback: Digoxin can cause gastrointestinal upset and increased urine output, so easy access to the bathroom is necessary. Mivacurium chloride is a neuromuscular junction blocker, not an antidote to digoxin toxicity. The client’s pulse should be monitored frequently, not just once per day. The drug should ideally be given on an empty stomach.

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Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4, 6 Page and Header: 785, Hyperpolarization-Activated Cyclic Nucleotide-Gated Channel Blockers: Therapeutic Actions and Indications 13. The nurse is caring for a client who has been diagnosed with heart failure and has been prescribed ivabradine. What assessment finding would best indicate a therapeutic effect? A) The client’s respiratory rate is 19 breaths/min, and rales are absent in both lungs. B) The client’s potassium level rises from 3.7 mmol/L (3.7 mEq/L) to 4.1 mmol/L (4.1 mEq/L). C) The client’s blood pressure changes from 144/93 to 138/90 mmHg over several hours. D) The client’s heart rate changes from 97 to 79 beats/min during the shift.

Ans: D

Feedback: Hyperpolarization-activated cyclic nucleotide-gated channel blockers slow the heart’s pacemaker, the sinus node, in the repolarizing phase of the action potential. This leads to a reduction in heart rate. Blood pressure is minimally affected, and there is no direct effect on respiratory function or potassium levels.

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 4, 5 Page and Header: 776, Focus on Drug Therapy Across the Lifespan: Agents to Treat HF: Children, Box 44.2; 785, Hyperpolarization-Activated Cyclic Nucleotide–Gated Channel Blockers: Contraindications and Cautions 14. The nurse is preparing to administer ivabradine to an 8-month-old client who has been diagnosed with dilated cardiomyopathy. What criteria will the nurse use when validating the prescribed medication dosage? A) temperature B) blood pressure C) weight D) respirations

Ans: C

Feedback: A child greater than 88 lb (40 kg) will be dosed at 2.5 to 5 mg; less than 88 lb (40 kg) will have a starting dose of 0.05 mg/kg. Children less than 6 months would not be prescribed the medication. Neither temperature nor respiratory rate is criteria for calculating medication dosage in this situation.

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 4, 5 Page and Header: 781, Cardiotonic Agents: Prototype Summary: Digoxin 15. After administering an intravenous (IV) dose of digoxin to a client, the nurse would expect to see effects within what period of time? A) 30 to 120 minutes B) 5 to 30 minutes

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C) 60 to 90 minutes D) 90 to 120 minutes

Ans: B Feedback: The drug has a rapid onset of action and rapid absorption (30 to 120 minutes when taken orally, 5 to 30 minutes when given IV).

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 779, Cardiotonic Agents: Cardiac Glycosides: Clinically Important Drug–Drug Interactions 16. The 96-year-old client is receiving digoxin and furosemide. In the morning, the client reports having a headache and feeling nauseated. What should the nurse do first? A) Contact the client’s primary health care provider immediately. B) Check the client’s laboratory values and vital signs. C) Administer acetaminophen and aluminum hydroxide/magnesium hydroxide. D) Give the client clear liquids and have the client lie down.

Ans: B

Feedback: The nurse will check the client’s digoxin level and electrolytes. Assessing vital signs is important because the risk of cardiac arrhythmias could increase due to the client’s receiving furosemide, which is a potassium-wasting diuretic. The adverse effects most frequently seen with the cardiac glycosides include headache, weakness, drowsiness, and vision changes (a yellow halo around objects is often reported). Gastrointestinal (GI) upset and anorexia also commonly occur. Only after checking lab values and assessing vital signs might the nurse call the health care provider.

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Acetaminophen and aluminum hydroxide/magnesium hydroxide (antacid) would not be indicated. Having the client lie down and restricting the diet to clear liquids would be appropriate but not the first actions.

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4, 6 Page and Header: 782, Cardiotonic Agents: Nursing Considerations for Patients Receiving Cardiac Glycosides: Intervention with Rationale 17. The nurse provides teaching about digoxin to a client who will be self-administering the drug at home. Which statement by the client indicates to the nurse further teaching is needed? A) “I’ll take the medication daily each morning.” B) “I’ll take my pulse before taking my dose.” C) “I’ll weigh myself daily at the same time.” D) “I’ll take the medication with food so I don’t get nauseous.”

Ans: D

Feedback: Digoxin should not be taken with food or antacids to avoid delays in absorption. The other answers are appropriate actions for the client to take when selfadministering digoxin.

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 6 Page and Header: 783, Cardiotonic Agents: Phosphodiesterase Inhibitors: Adverse Effects 18. The nurse is administering milrinone to a client with heart failure. The nurse should prioritize what assessment when monitoring the client for common adverse effects? A) capillary blood glucose B) orientation to person, place, and time C) blood pressure D) respiratory rate

Ans: C

Feedback: The adverse effects most frequently seen with these drugs are ventricular arrhythmias (which can progress to fatal ventricular fibrillation), hypotension, and chest pain. Hypoglycemia, confusion, and changes in respiratory function are not generally adverse effects of milrinone.

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5, 6 Page and Header: 786, Hyperpolarization-Activated Cyclic Nucleotide–Gated Channel Blockers: Assessment: History and Examination 19. The nurse is caring for a client who has been diagnosed with heart failure and has been prescribed ivabradine 5 mg PO twice a day. Before administering the drug, the nurse’s assessment reveals: temperature 97.2°F (36.2°), blood pressure 106/63 mmHg,

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apical heart rate 68 beats/min with regular rhythm, and respiratory rate of 21 breaths/min. What is the nurse’s best action? A) Contact the client’s primary health care provider. B) Withhold the medication. C) Reassess the client in 30 minutes. D) Administer the medication as prescribed.

Ans: D

Feedback: None of this client’s vital signs preclude the safe and effective use of ivabradine. A pulse of less than 60 beats/min and/or hypotension would require further direction.

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4, 6 Page and Header: 775, Cardiotonic Agents: Therapeutic Actions and Indications 20. A nurse assesses a client after administering digoxin. What finding indicates the drug is having the desired effect? A) increased oxygen saturation B) increased urinary output C) decreased respiratory rate D) increased heart rate

Ans: B

Feedback: As cardiac output improves, so does urinary output due to increased renal perfusion. Respiratory rate and oxygen saturation would not be impacted by the drug.

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Heart rate would decrease as the force of contraction increases, ejecting more blood with each contraction.

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 772, Heart Failure: Left-Sided Heart Failure 21. What assessment finding indicates to the nurse that a client’s left-sided heart failure is worsening? A) increased jugular venous pressure B) liver enlargement C) increased crackles in lung fields D) increased pulse rate

Ans: C

Feedback: Fluid may accumulate in the lungs due to left-sided heart failure. Clients may evidence dyspnea, tachypnea, and orthopnea. Right-sided failure would include increased jugular venous pressure and liver enlargement. Pulse rate could increase or decrease depending on medications administered.

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Objective: 4 Page and Header: 786, Angiotensin Receptor Neprilysin Inhibitor 22. The nurse is providing education on cardiovascular medications to a group of clients. Which drug would the nurse indicate is in the class of drugs called angiotensin receptor neprilysin inhibitors? A) bosentan B) milrinone C) digoxin D) sacubitril

Ans: D

Feedback: Sacubitril is the only drug currently available in a class of drugs called angiotensin receptor neprilysin inhibitors. Digoxin is a cardiac glycoside. Milrinone is a phosphodiesterase inhibitor. Bosentan is an endothelin receptor antagonist.

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 4, 6 Page and Header: 777, Cardiotonic Agents: Contraindications and Cautions 23. The nurse reviews the laboratory results of a client taking digoxin. What finding creates a risk for digoxin toxicity? A) chloride 98 mmol/L (98 mEq/L) B) potassium 3.3 mmol/L (3.3 mEq/L) C) sodium 144 mmol/L (144 mEq/L) D) hemoglobin 133 g/L (13.3 g/dL)

Ans: B

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Feedback: Electrolyte abnormalities such as hypokalemia could alter the action potential and change the effects of digoxin. Hypernatremia does not have this effect. Alterations in hemoglobin and chloride levels do not have this effect.

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 4 Page and Header: 775, Cardiotonic Agents 24. The nurse is caring for a client who has been prescribed cardiac glycosides and phosphodiesterase inhibitors. What common action do both of these medications have in common related to therapeutic action? A) blocking the enzyme phosphodiesterase B) increasing cellular calcium C) developing ventricular arrhythmias D) metabolizing in the liver and excreted in the urine

Ans: B

Feedback: The phosphodiesterase inhibitors block the enzyme phosphodiesterase. This blocking effect leads to an increase in myocardial cell cyclic adenosine monophosphate (cAMP), which increases calcium levels in the cell. Increased cellular calcium causes a stronger contraction and prolongs the effects of sympathetic stimulation, which can lead to vasodilation, increased oxygen consumption, and arrhythmias. Digoxin also increases intracellular calcium and allows more calcium to enter myocardial cells during depolarization. Most digoxin is not metabolized and is excreted unchanged.

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Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 772, Heart Failure: Left-Sided Heart Failure 25. The nurse evaluates an improvement in the client’s heart failure (HF) status on the basis of what assessment finding? A) using fewer pillows to sleep B) increased skin turgor C) heart rate regular D) improved mental status

Ans: A

Feedback: The degree of HF is often calculated by the number of pillows required to get relief (e.g., one-pillow, two-pillow, or three-pillow orthopnea). Fluid overload is associated with HF so skin turgor is not an indicator of improvement. Regular heart rate and normal cognition can be found with acute flare-ups of HF so these findings would not indicate improvement.

Format: Multiple Selection Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4, 6 Page and Header: 777, Cardiotonic Agents: Adverse Effects; 778, Digoxin Toxicity and Nursing Considerations, Box 44.3

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26. The nurse suspects the client may have toxic levels of digoxin in the bloodstream when which finding is noted? Select all that apply. A) irregular heart rhythms B) nausea C) anorexia D) hemorrhage E) peripheral edema

Ans: A, B, C

Feedback: Digoxin toxicity is a serious syndrome that can occur when digoxin levels are too high. The client may present with anorexia, nausea, vomiting, malaise, depression, irregular heart rhythms including heart block, atrial arrhythmias, and ventricular tachycardia. Peripheral edema is indicative of heart failure, not digoxin toxicity. Hemorrhage is not usually associated with digoxin toxicity.

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 782, Cardiotonic Agents: Phosphodiesterase Inhibitors: Therapeutic Actions and Indications 27. The client with heart failure has been prescribed milrinone. Before administering the drug, the nurse needs to know the drug has what pharmacokinetic effect? A) vasoconstriction of vessels B) decrease in cardiac output C) increase in cardiac preload D) increase in cyclic adenosine monophosphate (cAMP)

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Ans: D

Feedback: Milrinone is a phosphodiesterase inhibitor that blocks the enzyme phosphodiesterase. This blocking effect leads to an increase in myocardial cell cAMP, which increases calcium levels in the cell. These drugs do not decrease cardiac output or increase cardiac preload. These drugs result in inotropic and vasodilatory effects.

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 783, Cardiotonic Agents: Phosphodiesterase Inhibitors: Contraindications and Cautions 28. The client is newly prescribed milrinone. The nurse recognizes the drug is contraindicated due to the client’s allergy to which group of medication? A) penicillin B) salicylates C) opioids D) bisulfites

Ans: D

Feedback: Phosphodiesterase inhibitors are contraindicated in the presence of allergy to the drug or to bisulfites. Penicillin, salicylates, and opioids have no contraindications when used with milrinone.

Format: Multiple Choice Chapter: 44

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 786, Angiotensin Receptor Neprilysin Inhibitor 29. The nurse administers sacubitril to a client. The nurse will expect which action to occur? A) decrease blood volume B) increase force of cardiac contraction C) increase in peripheral resistance D) increase blood pressure

Ans: A

Feedback: Neprilysin is the enzyme that breaks down natriuretic peptides in the body. These peptides are responsible for loss of sodium and resultant water in response to ventricular overload. By blocking their breakdown, their effects last longer and more sodium and water are lost. This effect in combination with blocking the angiotensin II receptors, which inhibits the effects of the RAAS, leads to decreased cardiac workload, lower vascular volume, lower blood pressure, and improved HF symptoms. Cardiac glycosides increase force of contraction.

Format: Multiple Selection Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1, 2 Page and Header: 771, Heart Failure: Compensatory Mechanisms

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30. The nurse is working with a client who has been diagnosed with heart failure. What compensatory mechanisms will this client’s body be implementing? Select all that apply. A) increased heart rate B) irregular heart rate C) increased blood pressure D) suppression of the renin–angiotensin–aldosterone system E) increased force of cardiac contraction

Ans: A, C, E

Feedback: Decreased cardiac output stimulates the baroreceptors in the aortic arch and the carotid arteries, causing a sympathetic stimulation (see Chapter 29). This sympathetic stimulation causes an increase in heart rate, blood pressure, and rate and depth of respirations, as well as a positive inotropic effect (increased force of contraction) on the heart and an increase in blood volume (through the release of aldosterone). The decrease in cardiac output also stimulates the release of renin from the kidneys and activates the renin–angiotensin–aldosterone system, which further increases blood pressure and blood volume. Irregular heart rate would exacerbate the problem. Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 4, 6 Page and Header: 776, Drugs in Focus: HF Treatment Agents, Table 44.1 31. The nurse prepares to administer a phosphodiesterase inhibitor to a client. Which route will the nurse use to administer the medication? A) oral B) intravenous C) subcutaneous D) intramuscular

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Ans: B

Feedback: Phosphodiesterase inhibitors are only given intravenously (IV). They cannot be given orally, intramuscularly, or subcutaneously.

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 4, 6 Page and Header: 779, Cardiotonic Agents: Clinically Important Drug–Drug Interactions; 779, Focus on Herbal and Alternative Therapies, Box 44.4 32. The nurse is caring for a client who has digoxin toxicity. As the nurse assesses the changes in the client’s daily activities, what finding concerns the nurse? A) The client has been sleeping more over the past week. B) The client took nitroglycerin for chest pain twice yesterday. C) The client has been snacking on a bag of licorice. D) The client’s intake of sodium increased lately from seafood consumption.

Ans: C

Feedback: Increased digoxin toxicity has been reported with ginseng, hawthorn, and licorice. Clients should be advised to avoid these combinations. Increased sodium intake will exacerbate the client’s heart failure, which might explain why the client is sleeping more and requiring nitroglycerin, but these actions did not contribute to the digoxin toxicity.

Format: Multiple Choice

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Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 778, Focus on The Evidence: Digoxin Toxicity and Nursing Considerations, Box 44.3 33. The nurse admits a client to the constant care unit with a digoxin level of 11 ng/mL (14.09 nmol/L) and a serum potassium level of 5.2 mEq/L (5.2 mmol/L). Digoxin immune fab is administered. The next day, the client’s digoxin level remains elevated. What action does the nurse anticipate? A) Administer digoxin immune fab again. B) Administer a reduced dosage of digoxin. C) Continue to monitor the client’s digoxin level daily. D) Notify the health care provider of the elevated level.

Ans: C

Feedback: Serum digoxin levels will be very high and unreliable for about 3 days after the digoxin immune fab infusion because of the high levels of digoxin in the blood. The client should not be redigitalized for several days to 1 week after digoxin immune fab has been used, because of the potential of fragments remaining in the blood. There is no need to notify the health care provider or to administer digoxin immune fab again.

Format: Multiple Selection Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4

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Page and Header: 778, Focus on The Evidence: Digoxin Toxicity and Nursing Considerations, Box 44.3 34. The nurse is preparing to administer a digitalizing dosage of digoxin to an older adult client. What factors will the nurse assess for in order to avoid digoxin toxicity? Select all that apply. A) renal function B) low body mass C) hydration D) assessment of pulse E) cognitive function

Ans: A, B, C

Feedback: Factors that may contribute to elevated digoxin levels include impaired renal function, low body mass, and dehydration. Assessment of pulse and cognitive function are always important when caring for a geriatric client, but they will not contribute to elevated digoxin levels.

Format: Multiple Choice Chapter: 44 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 4, 6 Page and Header: 777, Cardiotonic Agents: Adverse Effects; 778, Focus on The Evidence: Digoxin Toxicity and Nursing Considerations, Box 44.3 35. A hospitalized client recently prescribed digoxin has reported beginning to experience a headache. What immediate action should the nurse take to best address the current situation? A) Dim the lights in the client’s room and administer an oral dose of acetaminophen. B) Assess the client’s heart rate and blood pressure and hold the next dose of digoxin.

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C) Notify the client’s primary health care provider and obtain a serum digoxin level. D) Assess the client for cardiac arrhythmias and perform a bedside electrocardiogram (EKG).

Ans: C

Feedback: The adverse effects most frequently seen with the cardiac glycosides include headache, weakness, drowsiness, and vision changes (a yellow halo around objects is often reported). Gastrointestinal (GI) upset and anorexia also commonly occur. It may be difficult to diagnose digoxin toxicity in adults with heart failure (HF) without drawing blood levels due to some of the signs and symptoms being similar to those of HF exacerbation and because of the varied causes of common headache. It is initially important to determine the digoxin blood level to rule out digoxin toxicity. Dimming the lights and acetaminophen will help manage the headache but not determine if the headache is related to toxicity. While assessing the client’s cardiac status is appropriate, the nurse should not hold the medication without first notifying the primary health care provider.

Test Generator Questions, Chapter 45, Antiarrhythmic Agents Format: Multiple Choice Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 797, Drugs in Focus: Antiarrhythmic Agents, Table 45.1 1. A client with a history of atrial fibrillation has undergone cardioversion. What drug would the nurse anticipate administering for long-term stabilization of this client? A) disopyramide B) moricizine

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C) procainamide D) quinidine (generic)

Ans: D

Feedback: Quinidine is often the drug of choice for long-term stabilization of atrial fibrillation after the rhythm is converted by electrocardioversion. Quinidine is a class I antiarrhythmic and stabilizes the cell membrane by binding to sodium channels, depressing phase 0 of the action potential, and changing the duration of the action potential. Disopyramide, moricizine, and procainamide are all used in the treatment of life-threatening ventricular arrhythmias.

Format: Multiple Choice Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 802, Class III Antiarrhythmics: Therapeutic Actions and Indications 2. The nurse is providing education to clients on antiarrhythmic drug classes. What class of antiarrhythmics drug will the nurse indicates blocks potassium channels, prolonging phase 3 of the action potential and slowing the rate and conduction of the heart? A) I B) II C) III D) IV

Ans: C

Feedback: The class III antiarrhythmics block potassium, prolonging phase 3 of the action potential, which prolongs repolarization and slows the rate and conduction of the

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heart. Class I drugs block the sodium channels in the cell membrane during an action potential. Class II drugs are beta-adrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential. Class IV drugs block calcium channels in the cell membrane leading to a depression of depolarization and a prolongation of phases I and II of repolarization, which slows automaticity.

Format: Fill-in-the-Blank Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 797, Drugs in Focus: Antiarrhythmic Agents, Table 45.1 3. The nurse is caring for a pediatric client who has been diagnosed with paroxysmal atrial tachycardia. The client is prescribed digoxin 10 mcg/kg orally. The child weighs 44 lb (20 kg). How many micrograms should the nurse administer?

Ans: 200 mcg

Feedback: The nurse will administer 200 mcg (20 kg (10) = 200 mcg).

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4. The nurse is providing drug teaching about quinidine in preparation for a client’s discharge. What dietary guidelines should the nurse provide to the client? A) “Avoid citrus juices and dairy products.” B) “If possible, drink two to three quarts of fluids per day.” C) “Avoid any processed food that contains added sodium.” D) “In general, avoid food that has been fermented, pickled, or aged.”

Ans: A

Feedback: Quinidine requires a slightly acidic urine (normal state) for excretion. Clients receiving quinidine should avoid foods that alkalinize the urine (e.g., citrus juices, vegetables, antacids, milk products), which could lead to increased quinidine levels and toxicity. Grapefruit juice has been shown to interfere with the metabolism of quinidine, leading to increased serum levels and toxic effects. Adequate fluid intake is necessary, but most clients do not need to drink two to three quarts of fluid per day. Controlling sodium intake is important for clients with cardiac disease, but this does not require abstinence from all processed foods. Foods that are fermented, pickled, or aged tend to be high in tyramines, but this is not problematic.

Format: Multiple Choice Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 801, Class II Antiarrhythmics: Adverse Effects 5. The nurse is caring for a client who reports insomnia since starting a prescribed antiarrhythmic agent. What antiarrhythmic agent would the nurse expect this client is taking? A) disopyramide B) amiodarone

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C) procainamide D) propranolol

Ans: D

Feedback: Class II antiarrhythmics can cause insomnia. The adverse effects associated with class II antiarrhythmics are related to the effects of blocking beta-receptors in the sympathetic nervous system. CNS effects include dizziness, insomnia, unusual dreams, and fatigue. Disopyramide and procainamide are class I agents and do not cause insomnia. Amiodarone is a class III drug and is not associated with insomnia.

Format: Multiple Choice Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 797, Drugs in Focus: Antiarrhythmic Agents, Table 45.1 6. A client with a history of atrial fibrillation has been successfully cardioverted and prescribed dofetilide. The nurse closely monitors the client’s cardiac status. What other factor should the nurse monitor during treatment? A) creatinine clearance B) red blood cell indices C) respiratory status D) white cell differential

Ans: A

Feedback: When giving dofetilide to a client with renal dysfunction, the dosage must be calculated according to the client’s creatinine level to ensure the therapeutic effect while

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limiting toxicity. Consequently, the nurse should monitor the client’s renal function. Red cell and white cell levels are not typically affected nor is the client’s respiratory status.

Format: Multiple Choice Chapter: 45 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 799, Class I Antiarrhythmics: Adverse Effects 7. A nurse is caring for a client who has been prescribed disopyramide. Before administering disopyramide, what is the nurse’s priority action to maintain safety? A) Offer the client something to drink. B) Determine if the client needs to void. C) Lower the bed and raise the side rails. D) Place the call button within reach.

Ans: C

Feedback: When administering disopyramide, the nurse should make sure that all side rails are up. The central nervous system effects of the drug can include dizziness, drowsiness, fatigue, twitching, mouth numbness, slurred speech, vision changes, and tremors that can progress to convulsions. The other three options are appropriate and placing the call button within reach can also be considered a safety measure; however, nothing has a higher priority than lowering the bed and raising the bed’s side rails.

Format: Multiple Choice Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 804, Antiarrhythmic Agents: Nursing Considerations for Patients Receiving Antiarrhythmic Agents: Assessment: History and Examination 8. The nurse is caring for a client who has been prescribed an antiarrhythmic agent. What nursing assessment should the nurse prioritize? A) mental status B) breath sounds and respiratory rate C) apical heart rate and blood pressure D) activity level and exercise tolerance

Ans: C

Feedback: The nurse should continually monitor cardiac rate and rhythm when administering an antiarrhythmic agent to detect potentially serious adverse effects and to evaluate drug effectiveness. Activity level, respiratory status, and cognition are all relevant assessments, but cardiac assessment is a key priority.

Format: Multiple Selection Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 801, Class II Antiarrhythmics: Adverse Effects 9. The nurse is caring for a client who is receiving propranolol. The nurse will monitor the client for which potential adverse effects? Select all that apply. A) seizures B) rash C) atrioventricular (AV) block

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D) bronchospasm E) bizarre dreams

Ans: C, D, E Feedback: The adverse effects associated with class II antiarrhythmics are related to the effects of blocking beta-receptors in the sympathetic nervous system. Central nervous system effects include dizziness, insomnia, unusual dreams, and fatigue. Cardiovascular symptoms can include hypotension, bradycardia, AV block, arrhythmias, and alterations in peripheral perfusion. Respiratory effects can include bronchospasm and dyspnea. GI problems frequently include nausea, vomiting, anorexia, constipation, and diarrhea. Other effects to anticipate include a loss of libido, decreased exercise tolerance, and alterations in blood glucose levels. Seizures and rash are not usually associated with the adverse effects of propranolol.

Format: Multiple Choice Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 804, Antiarrhythmic Agents: Nursing Considerations for Patients Receiving Antiarrhythmic Agents: Assessment: History and Examination 10. The nurse teaches a client receiving propranolol at home for management of a ventricular dysrhythmia to monitor what parameter? A) daily fluid intake B) daily blood pressure C) weekly weight D) weekly pulse

Ans: B

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Feedback: Hypotension can occur with propranolol, which is a beta-blocker, so clients should check their blood pressure and pulse every day. Propranolol does not require that fluid intake be measured. Propranolol also will not require daily weight taking, but it may be necessary with a diagnosis of propranolol.

Format: Multiple Choice Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4, 5 Page and Header: 800, Prototype Summary: Lidocaine 11. A client in the emergency department is unresponsive, and the monitor indicates ventricular tachycardia. Emergency resuscitation has begun. What is the nurse’s best action with regard to medication administration? A) Administer digoxin as prescribed. B) Prepare for the administration of lidocaine. C) Prepare for administration of quinidine. D) Administer acebutolol as prescribed.

Ans: B

Feedback: Lidocaine is the drug of choice for ventricular tachycardia. Digoxin, quinidine, and acebutolol are not among the medication options for treating ventricular tachycardia.

Format: Multiple Choice Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Page and Header: 797, Drugs in Focus: Antiarrhythmic Agents: Table 45.1 12. The nurse administers a bolus of lidocaine to a client with a life-threatening ventricular arrhythmia and follows it with a continuous infusion at what rate? A) 0.25 to 0.75 mg/min B) 1 to 4 mg/min C) 6 to 8 mg/min D) 10 to 20 mg/min

Ans: B

Feedback: Lidocaine may be delivered at 1 to 4 mg/min after a bolus. Therefore, the other options are incorrect.

Format: Multiple Choice Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 800, Class I Antiarrhythmics: Prototype Summary: Lidocaine 13. For what condition would the nurse expect to administer lidocaine intravenously to a client? A) decrease in arterial oxygen saturation (SaO2) B) precipitous increase in blood pressure C) multiple premature ventricular contractions (PVCs) D) increase in intracranial pressure (ICP)

Ans: C

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Feedback: Lidocaine drips are indicated for the treatment of life-threatening ventricular arrhythmias such as long or frequent runs of PVCs. Lidocaine would not be indicated for the treatment of hypoxia, hypertension, or increased ICP.

Format: Multiple Choice Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 4, 5 Page and Header: 801, Class II Antiarrhythmics: Adverse Effects 14. The nurse is caring for a client who takes an antiarrhythmic agent and is reporting a complete lack of appetite. Which cardiac antiarrhythmic agent would the nurse suspect the client is taking? A) diltiazem B) propranolol C) lidocaine D) amiodarone

Ans: B

Feedback: Propranolol frequently causes gastrointestinal (GI) problems such as nausea, vomiting, anorexia, constipation, and diarrhea. Diltiazem could cause nausea and vomiting but would not cause anorexia. Lidocaine can lead to changes in taste, nausea, and vomiting but does not cause anorexia. Amiodarone has adverse effects including nausea, vomiting, GI distress, weakness, dizziness, hypotension, heart failure, arrhythmia, a potentially fatal liver toxicity, and ocular abnormalities but does not cause anorexia.

Format: Multiple Choice

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Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4, 5 Page and Header: 797, Drugs in Focus: Antiarrhythmic Agents: Table 45.1 15. The nurse is responding to a code for an unresponsive client. The advanced cardiac life support (ACLS) protocol has been implemented. The nurse should prepare for administration of what medication? A) sotalol B) quinidine C) amiodarone D) dronedarone

Ans: C

Feedback: Amiodarone is the antiarrhythmic of choice in the advanced cardiac life support protocol. Quinidine and dronedarone are more commonly used for longer-term maintenance. Sotalol is not the drug of choice.

Format: Multiple Choice Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 797, Drugs in Focus: Antiarrhythmic Agents, Table 45.1 16. The nurse is reviewing the medication regimen of a newly admitted client. The client currently takes dofetilide 250 mcg PO twice a day. This client’s health history likely includes what diagnosis?

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A) atrial fibrillation B) hypertensive crisis C) ischemic heart disease D) ventricular tachycardia

Ans: A

Feedback: Dofetilide is indicated for conversion of atrial fibrillation or flutter to normal sinus rhythm and for maintenance of normal sinus rhythm after conversion for adults. It is not used for long-term treatment after ventricular tachycardia, hypertensive crisis, or ischemic heart disease.

Format: Multiple Choice Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 799, Class I Antiarrhythmics: Contraindications and Cautions 17. What client factor would result in the nurse administering a reduced dosage of disopyramide? A) dehydration B) hypertension C) renal impairment D) chronic diarrhea

Ans: C Feedback: Caution should be used with renal or hepatic dysfunction, which could interfere with the biotransformation and excretion of these drugs. Caution is not indicated with the findings of dehydration, hypertension, or chronic diarrhea.

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Ans: B

Feedback: Cardiac monitoring is imperative for determining therapeutic effect and monitoring the client’s status. Reassurance is likely a low priority, due to the client’s reduced levels of consciousness. Documentation is important, but cardiac monitoring is an even higher priority. Medication reconciliation is not performed during an emergency situation.

Format: Multiple Choice Chapter: 45 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 4

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Page and Header: 801, Class II Antiarrhythmics: Contraindications and Cautions 19. The nurse reviews a client’s medical history. What condition in the history does the nurse recognize as contraindicating class II antiarrhythmic medication administration for this client? A) asthma B) colitis C) migraine headache D) antidiarrheals

Ans: A

Feedback: Class II antiarrhythmic medications are contraindicated in clients with asthma because they could worsen the condition due to blockage of beta-receptors. They are not contraindicated in clients with colitis, migraine headache, or diarrhea.

Format: Multiple Choice Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 793, Understanding Atrial Fibrillation, Box 45.1 20. The nurse is caring for a client who has a history of atrial fibrillation (AF) and whose condition has recently worsened. The client is awaiting cardioversion. In addition to cardiac monitoring, what assessment should the nurse prioritize? A) Carefully monitor the client’s fluid balance. B) Review the client’s electrolyte levels. C) Monitor the client for signs of a pulmonary embolism. D) Assess the client for a myocardial infarction.

Ans: C

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Feedback: In clients with AF, there is a substantial risk that clots or emboli will be pumped into the ventricles and then into the lungs (from the right auricle), which could lead to pulmonary emboli, or to the brain or periphery (from the left auricle), which could cause a stroke or occlusion of peripheral vessels. Fluid balance and electrolytes are relevant, but secondary, concerns. AF does not directly affect coronary circulation.

Format: Multiple Choice Chapter: 45 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 793, Arrhythmias: Types of Arrhythmias 21. The nurse assesses a client’s cardiac rhythm and notes several premature ventricular contractions (PVCs). The nurse knows that stimulation of the ventricles from what location causes PVCs? A) ectopic focus in the ventricles B) atrioventricular node C) Purkinje fibers D) bundle of His

Ans: A Feedback: Premature ventricular contractions are stimulations of the cells caused by an ectopic focus in the ventricles causing an early contraction. The source of these ectopic foci could be anywhere within the ventricles, but the end result is reduced cardiac output due to reduced force of contraction.

Format: Multiple Choice Chapter: 45

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Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 792, Introduction 22. A nurse is caring for a client with an arrhythmia. What is the priority goal for this client? A) Maintain nutritional intake. B) Maintain fluid intake. C) Maintain cardiac output. D) Maintain urine output.

Ans: C

Feedback: Disruptions in the normal rhythm of the heart can interfere with myocardial contractions and affect the cardiac output, the amount of blood pumped with each beat. Arrhythmias that seriously disrupt cardiac output can be fatal. Therefore, the primary goal of treating a cardiac arrhythmia is to maintain adequate cardiac output to support life. The other goals may be important to individual client care, but sustaining life takes priority.

Format: Multiple Choice Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 796, Focus on Drug Therapy Across the Lifespan-Antiarrhythmic Agents: Children, Box 45.2

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23. A pediatric client is diagnosed with Wolff–Parkinson–White syndrome. The nurse provides the parents with information regarding which option as the most likely method of treatment? A) ablation B) emergency treatment with procainamide C) long-term management with propranolol D) close monitoring until the client outgrows the symptoms

Ans: A

Feedback: In Wolff–Parkinson–White (WPW) syndrome, an extra signaling pathway between the heart’s upper and lower chambers causes a fast heartbeat (tachycardia). The symptoms tend to increase progressively with age. WPW has been successfully treated with ablation techniques to destroy the arrhythmia-producing cells. Propranolol and procainamide have been successfully used to treat supraventricular arrhythmias, with propranolol being the drugs of choice for long-term management.

Format: Multiple Choice Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 799, Class I Antiarrhythmics: Adverse Effects 24. The nurse suspects drug toxicity in the client who has been receiving lidocaine by infusion to control a ventricular arrhythmia. What assessment should the nurse perform to determine the accuracy of the suspicion of toxicity? A) neurological assessment B) serum lidocaine level C) renal function studies D) hepatic function studies

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Ans: B

Feedback: If lidocaine is used for ventricular arrhythmias related to cardiac surgery or digoxin toxicity, serum levels should be monitored regularly to determine the appropriate dose and to avoid the potential for serious proarrhythmias and other adverse effects. Neurological assessment may indicate adverse effects but would not confirm lidocaine toxicity. Renal and hepatic function would not confirm lidocaine toxicity.

Format: Multiple Choice Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 793, Understanding Atrial Fibrillation, Box 45.1 25. The nurse performs an electrocardiogram (ECG) and finds the older adult client is in atrial fibrillation (AF). The date of onset is unknown but could be as long as 3 months earlier when the client was last assessed. What drug will the nurse expect to be prescribed? A) anticoagulant B) digoxin C) quinidine D) angiotensin-converting enzyme (ACE) inhibitor

Ans: A

Feedback: If the onset of AF is not known and it is suspected that the atria may have been fibrillating for longer than 1 week, the client is better off staying in AF without drug therapy or electrocardioversion. Prophylactic oral anticoagulants are given to decrease the risk of clot formation and emboli being pumped into the system. Conversion in this

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case could result in potentially life-threatening embolization of the lungs, brain, or other tissues. Administration of other antiarrhythmics or ACE inhibitors would not be indicated.

Format: Multiple Choice Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 1, 4 Page and Header: 798, Class I Antiarrhythmics: Therapeutic Actions and Indications 26. A nurse is caring for a client in symptomatic paroxysmal tachycardia. What class of antiarrhythmics will the nurse administer to markedly depress phase 0 with extreme slowing of conduction? A) class Ib B) class Ic C) class II D) class III

Ans: B

Feedback: Class Ic drugs markedly depress phase 0, with a resultant extreme slowing of conduction, but have little effect on the duration of the action potential. As a result, they are indicated for the treatment of paroxysmal tachycardia. Class Ib drugs depress phase 0 somewhat and actually shorten the duration of the action potential. The class II antiarrhythmics are beta-adrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential. The class III antiarrhythmics block potassium channels and slow the outward movement of potassium during phase 3 of the action potential, thus prolonging it.

Format: Multiple Choice

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Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 1, 4 Page and Header: 802, Antiarrhythmic Agents: Therapeutic Actions and Indications 27. What class of antiarrhythmic agents does the nurse administer to a client to slow the outward movement of potassium during phase 3 of the action potential? A) class Ib B) class Ic C) class II D) class III

Ans: D

Feedback: The class III antiarrhythmics block potassium channels and slow the outward movement of potassium during phase 3 of the action potential, prolonging it. Class Ib drugs depress phase 0 somewhat and actually shorten the duration of the action potential. Class Ic drugs markedly depress phase 0, with a resultant extreme slowing of conduction but have little effect on the duration of the action potential. The class II antiarrhythmics are beta-adrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential.

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28. What class of antiarrhythmic agents does the nurse administer to a client to depress generation of the action potentials and delaying phases 1 and 2 of repolarization? A) class Ib B) class II C) class III D) class IV

Ans: D

Feedback: The class IV antiarrhythmics block the movement of calcium ions across the cell membrane, depressing the generation of action potentials and delaying phases 1 and 2 of repolarization, which slows automaticity and conduction. Class Ib drugs depress phase 0 somewhat and actually shorten the duration of the action potential. The class II antiarrhythmics are beta-adrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential. The class III antiarrhythmics block potassium channels and slow the outward movement of potassium during phase 3 of the action potential, thus prolonging it.

Format: Multiple Selection Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 802, Class III Antiarrhythmics 29. The nurse is teaching a class for clients and is educating on dronedarone. What statement, if made by the nurse, is accurate? Select all that apply. A) “Dronedarone is available only in an oral form.” B) “Dronedarone is contraindicated for clients with permanent atrial fibrillation.” C) “Dronedarone has been found to be safe for use during pregnancy.” D) “Prolonged QT interval is a common adverse effect of dronedarone.”

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E) “Common adverse effects of dronedarone include headache and insomnia.”

Ans: A, B, D

Feedback: Dronedarone is administered only in oral form and is contraindicated for clients with permanent AF. The most common adverse effects seen with dronedarone are heart failure, prolonged QT interval, nausea, diarrhea, and rash. It should never be used during pregnancy because it has been associated with fetal abnormalities.

Format: Multiple Choice Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3 Page and Header: 796, Focus on Drug Therapy Across the Lifespan: Antiarrhythmic Agents: Adults, Box 45.2 30. The nurse is caring for a female client who has been prescribed a class II antiarrhythmic. The client informs the nurse, “I do breastfeed my 6-month-old baby.” What is the nurse’s best action? A) Contact the primary health care provider to question this use of the drug. B) Assess the client and administer the drug as prescribed. C) Inform the client it would be best for her to stop breastfeeding. D) Withhold the drug and document in the client’s medical record.

Ans: B

Feedback: Class I, III, and IV agents should not be used during lactation; if they are needed, another method of feeding the baby should be used. This leaves only class II drugs for consideration if the client is breastfeeding. There is no obvious reason to

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contact the care primary health care provider or withhold the drug, which the nurse cannot independently do.

Format: Multiple Choice Chapter: 45 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 805, Nursing Considerations for Patients Receiving Antiarrhythmic Agents: Intervention with Rationale 31. The nurse is caring for a 67-year-old client who is new to the community. The client’s history indicates long-term antiarrhythmic medication therapy. What nursing intervention will be added to the plan of care to best assure appropriate evaluation of the client’s expected outcomes? A) Discuss with the client any possible barriers to medication therapy adherence that exists. B) Provide for cardiac rhythm assessment at each scheduled follow-up visit. C) Assess the client’s understanding of the cardiac condition and medication therapy regime. D) Provide information regarding safety precautions in the event that central nervous system (CNS) effects occur.

Ans: B

Feedback: This client’s outcomes are focused on the stabilization of cardiac rhythm and output. Arranging for periodic monitoring of cardiac rhythm for a client receiving longterm therapy is necessary to evaluate effects of the medication on the client’s cardiac status. While the remaining options are all appropriate, only the cardiac rhythm assessment focuses on the evaluation of stated expected outcomes.

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Test Generator Questions, Chapter 46, Antianginal Agents Format: Multiple Choice Chapter: 46 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 812, Coronary Artery Disease: Angina 1. A nurse is providing education to a client who has been experiencing unstable angina. What is the nurse’s best explanation of this condition? A) “A coronary vessel has become completely plugged and is unable to deliver blood to your heart.” B) “The pain is caused by a spasm of a blood vessel, not just from the vessel narrowing.” C) “There is serious narrowing of a coronary artery causing a reduction in oxygen to the heart.” D) “Your body’s response to a lack of oxygen in the heart muscle is causing the pain you are feeling.”

Ans: C

Feedback: Unstable angina is described as increased narrowing of coronary arteries with the heart experiencing episodes of ischemia even at rest. If a coronary vessel is completely occluded and unable to deliver blood to the cardiac muscle, a myocardial infarction has occurred. Prinzmetal angina is an unusual form of angina caused by spasm of the blood vessel and not just by vessel narrowing. Although pain is the body’s response to ischemia in the heart muscle, this description could encompass angina or a myocardial infarction and is not specific enough to explain the condition.

Format: Multiple Choice

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Chapter: 46 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 821, Beta-Adrenergic Blockers: Adverse Effects 2. The nurse is working with a client who is taking nadolol for angina. What action should the nurse perform to best address the likely adverse effects? A) Ensure that the client sips water throughout the day to relieve dry mouth. B) Spread out the client’s activities to prevent fatigue or overexertion. C) Administer stool softeners to the client as prescribed. D) Have the client void on a scheduled basis at the beginning of therapy.

Ans: B

Feedback: Nadolol is a beta-blocker that can cause a decreased tolerance to exercise because of the inability to experience the effects of the stress reaction. Dry mouth and constipation are often seen with anticholinergic drugs but not with beta-blockers. There is no need to have the client void because urinary function is rarely affected.

Format: Multiple Choice Chapter: 46 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 822, Calcium Channel Blockers: Clinically Important Drug–Drug Interactions 3. Diltiazem has been prescribed for a client who has been taking cyclosporine to prevent rejection of a kidney transplant. What is the nurse’s best action?

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A) Ensure that the client is frequently assessed for signs and symptoms of diltiazem toxicity. B) Notify the primary health care provider about the potential for elevated or toxic cyclosporine levels. C) Monitor the client’s renal function closely for signs or symptoms of kidney rejection. D) Ensure that the client’s cyclosporine is administered at least 2 hours before or after diltiazem.

Ans: B

Feedback: Potentially serious adverse effects to keep in mind include increased serum levels and toxicity of cyclosporine if taken with diltiazem. This combination is not associated with diltiazem toxicity. Changing the timing of the medications does not remove the risk for cyclosporine toxicity. This drug would not cause rejection of a transplanted kidney.

Format: Multiple Choice Chapter: 46 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 816, Focus on Safe Medication Administration: Sublingual, Transbuccal, and Transdermal Administration of Nitroglycerin: Sublingual/transbuccal administration, Box 46.2 4. A client has received a new prescription for sublingual nitroglycerin. The nurse is teaching the client how to take the medication. What does the nurse instruct the client to do first? A) Check a radial pulse. B) Place the tablet in the buccal cavity. C) Take a sip of water.

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D) Lie down for 15 minutes before administration.

Ans: C

Feedback: The nurse should instruct the client to take a sip of water to moisten the mucous membranes, so the tablet will dissolve quickly. The client does not need to take the pulse or lie down before drug administration. For sublingual administration, the client will place the tablet under the tongue and not in the buccal cavity (cheek area).

Format: Multiple Choice Chapter: 46 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 3 Page and Header: 821, Beta-Adrenergic Blockers: Contraindications and Cautions 5. A nurse is caring for a client taking a beta-blocker and a nitrate to treat angina. The nurse recognizes the need for careful monitoring because of what comorbidity? A) chronic obstructive pulmonary disease (COPD) B) rheumatoid arthritis (RA) C) irritable bowel syndrome (IBS) D) chronic urinary tract infection (UTI)

Ans: A

Feedback: The nurse should assess for COPD, because the effect of beta-blockers in reducing effects of the sympathetic nervous system could exacerbate the respiratory condition. RA, IBS, and chronic UTIs are not affected by the use of beta-blockers or nitrates to treat angina.

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Format: Multiple Choice Chapter: 46 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4, 5 Page and Header: 823, Calcium Channel Blockers: Intervention with Rationale 6. A client with a long-standing diagnosis of angina has been prescribed nitroglycerin and diltiazem. In addition to monitoring the client’s heart rate, the nurse should prioritize what assessment? A) blood pressure B) level of consciousness C) daily weights D) respiratory status

Ans: A

Feedback: Concurrent use of nitrates and diltiazem creates a significant risk for hypotension, so the nurse should assess the client’s blood pressure carefully. Changes to LOC, respiratory status, and fluid balance (checked with daily weights) are less likely to result from this particular combination.

Format: Multiple Choice Chapter: 46 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 821, Beta-Adrenergic Blockers: Clinically Important Drug–Drug Interactions

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7. An older adult client who is taking metformin has just been seen in the clinic. The primary health care provider prescribes metoprolol for angina. What assessment data should the nurse prioritize due to this drug combination? A) white cell differential B) blood glucose C) urine specific gravity D) intake and output

Ans: B

Feedback: Metformin is an antidiabetic drug, and the nurse should monitor the client’s blood glucose frequently throughout the day because the client may not have the usual signs and symptoms of hypoglycemia or hyperglycemia. Urine specific gravity, leukocyte counts, and intake and output are less likely to be affected by this drug–drug combination.

Format: Fill-in-the-Blank Chapter: 46 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 813, Drugs in Focus: Antianginal Agents, Table 46.1 8. A client is prescribed diltiazem 360 mg/d orally in four divided doses. How many milligrams should the nurse administer per dose?

Ans: 90 mg

Feedback: The client will take 90 mg/dose (360 divided by 4 doses equals 90 mg/dose).

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Format: Multiple Choice Chapter: 46 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4, 5 Page and Header: 818, Nitrates: Nursing Considerations for Patients Receiving Nitrates: Intervention with Rationale 9. The client who has been diagnosed with angina reports chest pain. The client has a prescription for oral sublingual nitroglycerin as needed. What action should the nurse take? A) Place two nitroglycerin tablets under the client’s tongue and call the primary health care provider. B) Put one tablet under the client’s tongue and repeat every 5 minutes to a maximum of three tablets until pain has been relieved. C) Have the client swallow a tablet with an 8-ounce glass of water and repeat the same medication administration again in 10 minutes. D) Give the client one nitroglycerin table, placed under the client’s tongue, and then administer two more tablets in 5 minutes if pain remains.

Ans: B

Feedback: The correct administration for sublingual administration is to place one tablet under the client’s tongue and repeat every 5 minutes for a total of three tablets until pain is relieved. If pain is not relieved after three sublingual tablets, the primary health care provider should be notified. Nitroglycerin is not swallowed. Administering two tablets at one time would be an inappropriate dosage and could cause serious adverse effects.

Format: Multiple Choice Chapter: 46

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 815, Nitrates: Contraindications and Cautions 10. The nurse is caring for a client who reports chest pain. The nurse is to administer 40 mg of isosorbide dinitrate to the client. What assessment finding would contraindicate the safe use of this drug? A) platelets 202 ×109/L (202 ×103/µL) B) orientation to person and place but not time C) hemoglobin 88 g/L (8.8 g/dL) D) active sinusitis

Ans: C

Feedback: The nurse should assess for anemia because the decrease in cardiac output could be detrimental in a client who already has a decreased ability to deliver oxygen because of a low red blood cell count. Sinusitis would not be a contraindication to the drug. Decreased level of consciousness is not a contraindication. This client’s platelet level is within reference ranges.

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11. A 49-year-old client is admitted with uncontrolled chest pain. The client is currently taking nitroglycerin. The primary health care provider adds nifedipine to the client’s regimen. The nurse should observe the client for what adverse effect? A) hypokalemia B) renal insufficiency C) hypotension D) hypoglycemia

Ans: C

Feedback: Both nitroglycerin and nifedipine have hypotension as a potential adverse effect, so frequent assessment of blood pressure is important. Other cardiovascular effects include bradycardia, peripheral edema, and heart block. Skin effects include flushing and rash. Adverse effects do not include renal insufficiency, hypokalemia, or hypoglycemia.

Format: Multiple Choice Chapter: 46 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4. 5 Page and Header: 818, Nitrates: Nursing Considerations for Patients Receiving Nitrates: Intervention with Rationale 12. A nurse is teaching a 54-year-old client how to take sublingual nitroglycerin. What statement by the client indicates an understanding of the nurse’s instructions? A) “A headache means a toxic level has been reached.” B) “I can take up to three tablets at 5-minute intervals.” C) “I can take the drug as needed because it is not habit forming.” D) “If I become dizzy after taking the medication, I should stop taking it.”

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Ans: B

Feedback: Sublingual nitroglycerin may be taken at 5-minute intervals up to a maximum of three doses to relieve anginal chest pain. Headaches are very common due to vasodilation and do not indicate a toxic level. Nitroglycerin causes significant peripheral vasodilation in addition to its therapeutic effects of coronary artery dilation, so no more than three tablets should be taken, even though it is not habit forming. Dizziness could be an adverse effect of the drug or a manifestation of inadequate cardiac output, but it would not indicate that the client should stop taking it.

Format: Multiple Choice Chapter: 46 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 821, Beta-Adrenergic Blockers: Prototype Summary: Metoprolol 13. When the nurse administers a beta-adrenergic blocker to a client with angina, the nurse expects the drug will help to control angina. What other effect does a betaadrenergic blocker have? A) increased heart rate B) increased oxygen consumption C) decreased strength of heart muscle contraction D) decreased urinary output

Ans: C

Feedback: Beta-blockers competitively block beta-adrenergic receptors in the heart and kidneys, decreasing the influence of the sympathetic nervous system on these tissues and the excitability of the heart. As a result, it decreases the strength of cardiac

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contraction, reducing cardiac output, which results in lowered blood pressure and decreased cardiac workload. It does not impact urinary output.

Format: Multiple Choice Chapter: 46 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4, 5 Page and Header: 817, Nitrates: Prototype Summary: Nitroglycerin 14. The nurse is caring for a client who has been prescribed nitroglycerin sublingually. When providing client education, the nurse should tell the client to expect relief of chest pain within what period of time? A) 1 to 3 minutes B) 5 to 10 minutes C) 15 to 20 minutes D) 30 to 60 minutes

Ans: A

Feedback: Sublingual nitroglycerin acts within 1 to 3 minutes. The medication does not take 5 or more minutes to act. The primary health care provider should be notified if the medication does not work in the expected time.

Format: Multiple Choice Chapter: 46 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning

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Objective: 4, 5 Page and Header: 817, Nitrates: Prototype Summary: Nitroglycerin 15. When providing client education about nitroglycerin to the client, what should the nurse include in the teaching plan about a nitroglycerin patch? A) “It only has to be changed every 3 days.” B) “It is more effective than tablets in treating angina.” C) “One patch lasts an entire day.” D) “It is faster acting than the tablets.”

Ans: C

Feedback: Transdermal nitroglycerin has a long 24-hour duration of action compared with the sublingual form that lasts 30 to 60 minutes or oral tablets that last 8 to 12 hours. Transdermal patches are neither more nor less effective, but rather it is the speed of onset and duration of action that differ.

Format: Multiple Choice Chapter: 46 Client Needs: Health Promotion and Maintenance Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 820, Critical Thinking Scenario: Handling an Angina Attack: Patient Teaching for S.W. 16. Which statement by the client would lead the nurse to believe that the client has understood the teaching provided regarding angina? A) “I will not exercise because it precipitates angina.” B) “As long as I take the medicine, I can maintain my current lifestyle.” C) “There is no correlation between my hypertension and angina.” D) “Heavy meals and cigarette smoking can precipitate an angina attack.”

Ans: D

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Feedback: The client should avoid stressful activities, especially in combination. For example, if the client eats a big meal the client should not drink coffee or alcoholic beverages with that meal. If the client has just eaten a big meal, the client should not climb stairs; instead, the client should rest for a while. However, exercise is important and should not be eliminated, but managed in coordination with other activities. Smoking causes vasoconstriction that can result in angina attacks, so lifestyle changes like reducing fat and calories in the diet, moderate exercise, reducing alcohol intake, and avoiding smoking are all healthful choices. Hypertension does increase the risk of angina and coronary artery disease.

Format: Multiple Choice Chapter: 46 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 3, 5 Page and Header: 816, Nitrates: Adverse Effects 17. The nurse is caring for a client diagnosed with angina who is taking a calcium channel blocker. What adverse effects would the nurse caution this client about? A) hypertension and tachycardia B) headache and dizziness C) itching and rash D) nausea and diarrhea

Ans: B

Feedback: The adverse effects associated with these drugs are related to their effects on cardiac output and on smooth muscle. Central nervous system (CNS) effects include dizziness, light-headedness, headache, and fatigue. Gastrointestinal (GI) effects can include nausea and hepatic injury related to direct toxic effects on hepatic cells.

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Cardiovascular effects include hypotension, bradycardia, peripheral edema, and heart block. Skin effects include flushing and rash. The adverse effects do not, however, include diarrhea, hypertension, tachycardia, or itching.

Format: Multiple Choice Chapter: 46 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 816, Nitrates: Adverse Effects 18. A client diagnosed with angina has been prescribed nifedipine 15 mg PO three times a day. The client has received the first two doses of the medication and reports dizziness. What is the nurse’s best action? A) Reassure the client that this is an expected adverse effect. B) Report this finding to the client’s primary health care provider. C) Assess the client’s blood pressure. D) Withhold the next scheduled dose and implement falls precautions.

Ans: C

Feedback: If a client reports dizziness after beginning treatment with a calcium channel blocker, hypotension is a likely cause. The nurse should obtain objective data by assessing the client’s blood pressure before taking further action. The nurse should not independently withhold the drug. The nurse should assess the client before providing reassurance. There may be no need to report this to the primary health care provider if it is transient.

Format: Multiple Choice Chapter: 46

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 816, Nitrates: Clinically Important Drug–Drug Interactions 19. What adverse reaction does the nurse anticipate if a client takes nitroglycerin with sildenafil? A) hypotension B) bradycardia C) chest pain D) nausea Ans: A

Feedback: Clients should not combine nitrates with phosphodiesterase type 5 inhibitors (sildenafil, tadalafil, or vardenafil), drugs used to treat erectile dysfunction, because serious hypotension and cardiovascular events could occur. It is best to avoid this combination. Bradycardia, chest pain, and nausea are not associated with this drug combination.

Format: Multiple Choice Chapter: 46 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3 Page and Header: 815, Nitrates: Contraindications and Cautions 20. The nurse is caring for four clients. In which client would the use of a beta-blocker most likely be contraindicated? A) a client with angina pectoris who is trying to become pregnant B) a client who takes a bisphosphonate for osteoporosis and who has angina

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C) a client with angina who recently completed a course of moxifloxacin D) a client who has angina and diabetic retinopathy

Ans: A

Feedback: Pregnancy and lactation preclude the use of a beta-blocker. Beta-blockers can be used concurrently with bisphosphonates and antibiotics. Complications of diabetes do not preclude the use of beta-blockers for the treatment of angina.

Ans: A

Feedback: A sublingual dose may be repeated in 5 minutes if relief is not felt, for a total of three doses. If pain persists, the client should go to the emergency department. The client should not waste time by calling the primary health care provider or lying down. It would be unsafe to take more tablets.

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Format: Multiple Choice Chapter: 46 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 4 Page and Header: 821, Beta-Adrenergic Blockers: Prototype Summary: Metoprolol 22. The nurse is caring for a client who takes metoprolol for angina. The client asks the nurse how long it takes for the medicine to begin working. What is the nurse’s best response? A) 15 minutes B) 30 minutes C) 1 hour D) 90 minutes

Ans: A

Feedback: Oral metoprolol has an onset of action of 15 minutes. The nurse would provide the correct information to the client. Stating 30 minutes or more would be incorrect information.

Format: Multiple Choice Chapter: 46 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4, 5 Page and Header: 820, Critical Thinking Scenario: Handling an Angina Attack: Patient Teaching for S.W.

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23. The nurse is caring for a client who has been diagnosed with angina and has been prescribed nitroglycerin. What teaching about the client’s lifestyle should the nurse provide? A) “It’s important not to take nitroglycerin unless you’re actually experiencing chest pain.” B) “It is best for your health to eliminate or reduce your intake of alcoholic beverages.” C) “Since you are taking this medication, you need to avoid drinking grapefruit juice.” D) “You need to make sure that you are able to get at least 6 hours of sleep each night.”

Ans: B

Feedback: Clients should be taught to avoid or at least decrease use of coffee, cigarettes, and alcoholic beverages. Clients should ideally take nitroglycerin before the onset of chest pain. There is no particular need for adequate sleep, beyond the general benefits of this practice. Grapefruit juice does not interfere with the metabolism of nitroglycerin.

Format: Multiple Choice Chapter: 46 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 811, Introduction 24. An adult client experiences angina pectoris upon exertion. The nurse informs the client that the leading cause of angina is what? A) smoking B) inadequate cardiac output C) infarction of the myocardium D) coronary atherosclerosis

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Ans: D

Feedback: The client with atherosclerosis has a classic supply-and-demand problem. The heart may function without a problem until increases in activity or other stresses place a demand on it to beat faster or harder. Normally, the heart would stimulate the vessels to deliver more blood when this occurs, but the narrowed vessels are not able to respond and cannot supply the blood needed by the working heart. The heart muscle then becomes hypoxic. This imbalance between oxygen supply and demand is manifested as pain, or angina pectoris, which literally means “suffocation of the chest.” Atherosclerosis of the coronary artery can block the coronary artery completely leading to infarction. Smoking causes further vasoconstriction, increasing risk of myocardial infarction or angina. Damage to the heart muscle causes a decrease in cardiac output.

Format: Multiple Choice Chapter: 46 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 4 Page and Header: 814, Nitrates: Therapeutic Actions and Indications 25. After receiving relief from anginal pain, the client says to the nurse, “That nitroglycerin works great. How does it do that?” What is the nurse’s best response? A) “It decreases the amount of oxygen the heart needs to function.” B) “Nitroglycerin makes the coronary arteries open much wider.” C) “It promotes growth of new, smaller arteries to supply oxygen to the heart.” D) “This medication decreases preload and afterload.”

Ans: A

Feedback: The main effect of nitrates seems to be related to the drop in blood pressure that occurs. The vasodilation causes blood to pool in veins and capillaries, decreasing

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preload, while the relaxation of the vessels decreases afterload. The combination of these effects greatly reduces the cardiac workload and the demand for oxygen, thus bringing the supply-and-demand ratio back into balance. Because coronary artery disease causes a stiffening and lack of responsiveness in the coronary arteries, the nitrates probably have very little effect on increasing blood flow through the coronary arteries, so it would be incorrect to say that the coronary arteries become much wider. Although both preload and afterload are reduced, this is an explanation that the client would not understand, so it is inappropriate. Nitroglycerin does not promote growth of compensatory circulation.

Format: Multiple Choice Chapter: 46 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 817, Nitrates: Nursing Conclusions 26. An adult client experienced symptoms of unstable angina during admission to the hospital. Which finding most concerns the nurse? A) a lack of knowledge about the disease B) a fear of death C) ineffective tissue perfusion D) noncompliance with lifestyle changes

Ans: C

Feedback: The most concerning finding is ineffective tissue perfusion due to reduced oxygen supply to the heart because this is the cause of the client’s pain. Further assessment would be needed regarding the client’s lack of knowledge, fears death, and lifestyle changes; however, these are not priority over ineffective tissue perfusion.

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Format: Multiple Choice Chapter: 46 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 818, Nitrates: Nursing Considerations for Patients Receiving Nitrates: Evaluation 27. The nurse is preparing to administer sublingual nitroglycerin to a client for the first time. What effect might the client experience right after administration? A) nervousness or paresthesia B) throbbing headache or dizziness C) drowsiness or blurred vision D) tinnitus or diplopia

Ans: B

Feedback: Headache and dizziness commonly occur at the start of nitroglycerin therapy. When administering nitroglycerin, the nurse must use caution to avoid selfcontamination, especially with the topical paste formulation because the nurse can experience the same symptoms. However, the client usually develops a tolerance. Nervousness, paresthesia, drowsiness, blurred vision, tinnitus, and diplopia do not occur as a result of nitroglycerin therapy.

Format: Multiple Choice Chapter: 46 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process

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Objective: 2, 3 Page and Header: 824, Piperazine Acetamide Agent 28. The nurse is caring for a client who has been diagnosed with human immunodeficiency virus (HIV) and newly diagnosed with angina. What drug would the nurse question if prescribed? A) ranolazine B) nitroglycerin C) propranolol D) diltiazem

Ans: A

Feedback: Drug–drug interactions can occur with ketoconazole, diltiazem, verapamil, macrolide antibiotics, and HIV protease inhibitors; these combinations should be avoided because ranolazine levels may become extremely high. The nurse should get a complete list of current medications and consult with the health care provider regarding drug interactions before administering the medication as ordered. Nitroglycerin, propranolol, and diltiazem have no contraindication with medications used to treat HIV.

Format: Multiple Choice Chapter: 46 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 815, Focus on Drug Therapy Across the Lifespan: Antianginal Agents: Children, Box 46.1 32. The nurse is managing care for a 10-year-old client. Which diagnosis would cause the nurse to question a prescription for an antianginal medication? A) coronary artery disease (CAD) B) hypertension (HTN)

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C) migraines D) paroxysmal supraventricular tachycardia (PSVT)

Ans: A

Feedback: Nitrates, beta-blockers, calcium channel blockers, and piperazine acetamide are included in the classification of antianginal medication. Pediatric clients are not prescribed antianginal medications to treat CAD. However, some of antianginal medications are indicated for pediatrics to treat HTN, such as amlodipine, and/or cardiac dysrhythmia, such as PSVT. Prophylaxis migraine therapy is another use for the antianginal medication propranolol. Format: Multiple Selection Chapter: 46 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 2, 3, 5 Page and Header: 818, Nitrates: Intervention with Rationale 30. What would the nurse teach the client about the safe and effective use of nitroglycerin? Select all that apply. A) “The tablet should fizzle or burn when placed under the tongue.” B) “Protect the drug from heat and light.” C) “Always replace when past the expiration date.” D) “Older tablets may require you to use two tablets at one time.” E) “Nitroglycerin does not lose its potency easily.” Ans: A, B, C

Feedback: Ask the client if the tablet “fizzles” or burns, which indicates potency. Always check the expiration date on the bottle and protect the medication from heat and light because these drugs are volatile and lose potency easily. The client would not take more than the prescribed amount of one tablet regardless of the date the medication was filled. Nitroglycerin can lose potency if not properly stored and due to time.

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Format: Multiple Selection Chapter: 46 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 818, Nitrates: Interventions with Rationale 31. The nurse teaches the client how to use topical nitroglycerin patches. Which points will the nurse include in the teaching plan? Select all that apply. A) “Rotate application sites.” B) “Assess the skin for signs of breakdown.” C) “Make sure no one touches the side with the medication.” D) “Do not shower with the patch in place.” E) “Increase fluid intake to avoid low blood pressure.”

Ans: A, B, C

Feedback: Rotate the sites of topical forms of nitroglycerin to lower the risk of skin abrasion and breakdown; monitor for signs of skin breakdown to arrange for appropriate skin care as needed. Care should be taken not to touch the side of the patch with the medication by the client or anyone assisting in applying the patch. The client may shower with the patch in place. There is no need to increase fluid intake, but clients should be encouraged to maintain adequate intake.

Format: Multiple Choice Chapter: 46 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult

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Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 815, Nitrates: Contraindications and Cautions 32. A client has been diagnosed with angina and prescribed nitroglycerin. What aspect of the client’s health history should prompt the nurse to monitor the client particularly closely after administration of the drug? A) orthostatic hypotension B) chronic depression C) Raynaud’s syndrome D) gastroesophageal reflux disease (GERD)

Ans: A

Feedback: Underlying hypotension can be exacerbated by nitroglycerin, creating a risk for syncope or falls. GERD, depression, and Raynaud’s syndrome do not complicate the use of nitrates for angina.

Test Generator Questions, Chapter 47, Lipid-Lowering Agents Format: Multiple Choice Chapter: 47 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 839, Lipid-Lowering Agents: Nursing Considerations for Patients Receiving Bile Acid Sequestrants: Nursing Conclusions 1. The nurse is assessing a client who reports taking cholestyramine mixed with diet cola twice per day. What would the nurse assess the client for at this time? A) imbalanced nutrition B) constipation

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C) infection D) knowledge deficit

Ans: D

Feedback: Cholestyramine should be mixed with water or other noncarbonated fluids, so the nurse now recognizes the need for medication teaching and assesses the client’s level of knowledge deficit. Nothing in this question indicates that the client is experiencing any adverse effects from the drug, so constipation would not be assessed. This practice does not create a risk for infection or malnutrition.

Format: Multiple Choice Chapter: 47 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 834, Bile Acid Sequestrants: Adverse Effects 2. A client has had an exacerbation of hemorrhoidal irritation. What drug should the nurse suspect as most likely to contribute to this adverse effect? A) bile acid sequestrants B) hydroxymethylglutaryl–coenzyme A (HMG–CoA) reductase inhibitors C) cholesterol absorption inhibitor D) fibrates

Ans: A

Feedback: Direct gastrointestinal (GI) irritation, including nausea, constipation that may progress to fecal impaction, and aggravation of hemorrhoids, may occur with use of bile acid sequestrants. GI irritation, and specifically irritation of hemorrhoids, is not

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associated with use of HMG–CoA reductase inhibitors, cholesterol absorption inhibitors, or fibrates.

Format: Multiple Choice Chapter: 47 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 839, Bile Acid Sequestrants: Nursing Considerations for Patients Receiving Bile Acid Sequestrants: Interventions with Rationale 3. The nurse is teaching a client how to take a newly prescribed bile acid sequestrant. The nurse states, “You can mix this with soda or seltzer is you’d prefer.” What bile acid sequestrant is the nurse describing? A) cholestyramine B) colesevelam C) colestipol D) ezetimibe

Ans: C

Feedback: Colestipol can be mixed with a carbonated beverage. The mixture should be stirred, and all of the liquid should be swallowed. Ezetimibe is a cholesterol absorption inhibitor and comes in tablet form. The other two options are bile acid sequestrants but should not be taken with carbonated beverages. The carbonation interferes with the absorption of the drug.

Format: Multiple Selection Chapter: 47 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 839, HMG–CoA Reductase Inhibitors (Statins): Therapeutic Actions and Indications 4. The nurse is caring for a client who has been taking atorvastatin for several weeks. The nurse would inform the client that this medication should decrease which level? Select all that apply. A) serum cholesterol B) low-density lipoprotein (LDL) C) sitosterol D) campesterol E) high-density lipoprotein (HDL)

Ans: A, B Feedback: Atorvastatin is a beta-hydroxy-beta-methylglutaryl coenzyme A reductase inhibitor. This medication should lower serum cholesterol and LDL levels as well as prevent a first myocardial infarction and slow the progression of coronary artery disease. A decrease in serum cholesterol alone would result from the use of a bile acid sequestrant. A cholesterol absorption inhibitor would also decrease sitosterol and campesterol levels as well as decrease levels of serum cholesterol and LDL. A decrease in HDL levels is neither desired nor expected.

Format: Multiple Choice Chapter: 47 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3, 5

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Page and Header: 840, HMG–CoA Reductase Inhibitors (Statins): Contraindications and Cautions 5. The nurse is taking a health history on a 58-year-old client who is taking atorvastatin for high cholesterol. What assessment question should the nurse prioritize related to the safe use of this drug? A) “How many alcoholic drinks do you have in a typical day or week?” B) “How would you describe your caffeine intake?” C) “Do you do any physical exercise on a regular basis?” D) “Do you use any over-the-counter medications for headaches or colds?”

Ans: A

Feedback: Hydroxymethylglutaryl–coenzyme A (HMG–CoA) reductase inhibitors are contraindicated with active liver disease or a history of alcohol-related liver disease, so it is important for the nurse to ask about the client’s use of alcohol. For most clients, heavy alcohol use would be more dangerous than high caffeine intake or the use of OTC medications. Exercise has multiple benefits and should be encouraged by the nurse, but it is unrelated to safe medication use.

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D) constipation and flank pain

Ans: C

Feedback: The most common adverse effects of ezetimibe are mild abdominal pain and diarrhea. Bloating and flatulence are associated with bile acid sequestrants and the fibrates. Constipation is usually associated with bile acid sequestrants. Neuropathy and flank pain are usually not associated with lipid-lowering agents.

Format: Multiple Choice Chapter: 47 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 842, HMG–CoA Reductase Inhibitors (Statins): Nursing Considerations for Patients Receiving HMG–CoA Reductase Inhibitors (Statins): Intervention with Rationale 7. The nurse is preparing a client for discharge who will receive a prescription for a hydroxymethylglutaryl–coenzyme A (HMG–CoA) inhibitor. What statement by the client demonstrates a clear understanding of the teaching provided by the nurse? A) “I will not need to follow a low-fat diet anymore because this drug will take care of my lipids.” B) “I should plan to take this drug before bedtime, because my body makes lipids mostly at night.” C) “After I start taking this drug, I can scale back the exercise routine the primary health care provider prescribed.” D) “I should take this drug first thing in the morning and make sure I drink a full glass of water with it.”

Ans: B

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Feedback: HMG–CoA inhibitors should be taken at bedtime because the body produces lipids mostly at night. Diet and exercise are still important when taking these drugs because the drug is most effective in combination with other lipid-lowering actions.

Format: Multiple Choice Chapter: 47 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 841, HMG–CoA Reductase Inhibitors (Statins): Clinically Important Drug–Drug Interactions 8. A client taking atorvastatin presents to the clinic reporting acute muscle pain not associated with exercise or injury. The nurse asks questions to determine if this client has been taking what contraindicated substance? A) ibuprofen B) ginseng C) grapefruit juice D) saw palmetto

Ans: C

Feedback: Grapefruit juice can decrease the breakdown of atorvastatin, leading to increased serum levels and toxic adverse effects, including rhabdomyolysis. Clients on this drug should be cautioned to avoid drinking grapefruit juice. Ibuprofen, ginseng, and saw palmetto are not associated with increased toxicity.

Format: Multiple Choice Chapter: 47

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 840, HMG–CoA Reductase Inhibitors (Statins): Adverse Effects 9. A client recently began taking lovastatin. The nurse should assess the client for what potential adverse effects? A) nausea, flatulence, and constipation B) increased appetite and blood pressure C) confusion and mental disorientation D) hiccoughs, sinus congestion, and dizziness Ans: A

Feedback: GI problems such as nausea, vomiting, flatulence, constipation, or diarrhea can occur with lovastatin. Increased appetite is not associated with lovastatin, but clients may think that taking this drug means they can now eat anything they want and this would indicate the need for further teaching. Confusion and mental disorientation are not associated with this drug. Hiccoughs, sinus congestion, and dizziness would require exploration for cause because they are not normally associated with lovastatin therapy.

Format: Multiple Choice Chapter: 47 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 848, Other Lipid-Lowering Agents: Vitamin B3 10. The client receives a prescription for niacin, and the nurse is providing education about the medication. What should the nurse teach the client about possible adverse effects of the medication?

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A) “Sometimes this causes a full body rash when you first take it, but that doesn’t necessarily mean you’re allergic to it.” B) “You need to be aware that some people get very flushed skin when they take this medication.” C) “You’re likely to have some nausea when you begin taking the drug, but this will dissipate with time.” D) “It’s important to avoid eating shellfish and to tell providers before having any diagnostic imaging tests.”

Ans: B Feedback: Niacin is associated with intense cutaneous flushing, nausea, and abdominal pain, making its use somewhat limited. A full body rash should always be reported, and self-limiting nausea is not expected. There is no need to avoid shellfish or contrast solution when taking niacin.

Format: Multiple Choice Chapter: 47 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 848, Other Lipid-Lowering Agents; Vitamin B3 11. The nurse is providing medication teaching to a client who will begin taking niacin with a bile acid sequestrant. How should the nurse instruct the client to take these two medications? A) “The medications should be taken 4 to 6 hours apart in the evening.” B) “Both medications should be taken in the morning.” C) “One medication should be taken in the morning and the other at bedtime.” D) “Both medications can be taken together just before going to bed.”

Ans: A

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Feedback: When niacin is prescribed with a bile acid sequestrant, the client should be told to take the two medications 4 to 6 hours apart in the evening, with the niacin normally taken first. The medications should not be taken in the morning or together.

Format: Multiple Choice Chapter: 47 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 829, Focus on Sex Differences: Heart Disease in Female Patients: Box 47.3 12. A 49-year-old female client has been receiving hormone replacement therapy (HRT) for the past 4 years. The nurse should identify what relationship between HRT and coronary artery disease (CAD)? A) HRT initially reduces a client’s risk of CAD but then increases the risk after 5 years of HRT. B) HRT has recently been identified as a preventable risk factor for CAD. C) HRT creates a significant reduction in a client’s risks of CAD but cannot be tolerated by many clients. D) HRT can reduce a client’s risk of CAD by up to 30% but is associated with significant adverse effects.

Ans: A

Feedback: In several studies, female clients who received hormone replacement therapy (HRT) at menopause had a significantly reduced risk of CAD and myocardial infarction (MI) in the first few years after the onset of menopause. Research showed, however, that after 5 years of HRT, the incidence of MI and stroke rose sharply, leading to an early closure of the study.

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Format: Multiple Choice Chapter: 47 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 834, Bile Acid Sequestrants: Adverse Effects 13. The nurse is providing care for a client who has been prescribed cholestyramine for the treatment of hyperlipidemia. During the client’s latest clinic visit, the client states, “It seems like I bruise from the lightest little bumps or scrapes? What is the nurse’s best action? A) Reassure the client that this is an expected adverse effect of the medication. B) Teach the client safety measures so that the risk for injury is reduced. C) Inform the primary health care provider of the need for laboratory testing. D) Tell the client stop taking the medication at this time.

Ans: C

Feedback: The nurse should follow-up the client’s risk for bleeding by informing the primary health care provider and facilitating coagulation tests. Education about safety would be a relevant, but not sufficient, response. Reassurance does not address the client’s actual problem. The nurse should not independently instruct the client to stop taking a medication.

Format: Multiple Choice Chapter: 47 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 840, HMG–CoA Reductase Inhibitors (Statins): Adverse Effects 14. A client diagnosed with coronary artery disease has been prescribed fluvastatin. When reviewing this client’s recent laboratory values, what finding should the nurse attribute to adverse effects of this medication? A) decreased hemoglobin and hematocrit B) increased neutrophil levels C) decreased serum potassium levels D) increased liver enzyme levels

Ans: D

Feedback: Increased concentrations of liver enzymes commonly occur, and acute liver failure has been reported with the use of atorvastatin and fluvastatin. These medications are not normally associated with increased white cell levels, hypokalemia, or anemia.

Format: Multiple Choice Chapter: 47 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 827, Key Terms 15. The nurse explains to a client the action of a hydroxymethylglutaryl–coenzyme A (HMG–CoA) reductase inhibitor. What enzyme does the nurse state this drug inhibits? A) an enzyme that controls the production of cellular cholesterol B) an enzyme used immediately for energy C) an enzyme that combines with proteins to become chylomicrons D) an enzyme used to make bile acids

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Ans: A

Feedback: HMG–CoA reductase is an enzyme that controls the final step in production of cellular cholesterol. Some fats are used immediately for energy. Bile acids act like detergents to break down or metabolize fats into small molecules called micelles, which are absorbed into the intestinal wall and combined with proteins to become chylomicrons, to allow transport throughout the circulatory system. Cholesterol is a fat that is used to make bile acids.

Format: Multiple Selection Chapter: 47 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 1, 5 Page and Header: 828, Clinical Aspects of Metabolic Syndrome, Table 47.1 16. The nurse has completed a comprehensive assessment of a new client. What assessment findings would support a diagnosis of metabolic syndrome? Select all that apply. A) waist measurement 107 cm (42 in) B) high-density lipoprotein 1.29 mmol/L (50 mg/dL) C) blood pressure 148/93 mmHg D) resting heart rate 77 beats/min E) fasting blood glucose 7.2 mmol/L (121 mg/dL)

Ans: A, B, C, E

Feedback: This client’s waist circumference, blood pressure, HDL, and blood glucose levels are all significant for metabolic syndrome. Heart rate is not a component of the syndrome, and a resting heart rate of 77 beats/min is within norms for an adult.

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Format: Multiple Choice Chapter: 47 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3 Page and Header: 848, Other Lipid-Lowering Agents: Fibrates 17. A client diagnosed with coronary artery disease has been prescribed a medication that inhibits peripheral breakdown of lipids, reduces low-density lipoproteins (LDLs), and increases high-density lipoprotein (HDL) concentrations. What is this client most likely taking? A) fenofibrate B) niacin C) atorvastatin D) gemfibrozil

Ans: D

Feedback: Gemfibrozil inhibits peripheral breakdown of lipids, reduces production of triglycerides and LDLs, and increases HDL concentrations. It is associated with gastrointestinal (GI) and muscle discomfort. Fenofibrate, niacin, and atorvastatin do not increase HDL concentrations.

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Page and Header: 842, HMG–CoA Reductase Inhibitors (Statins): Nursing Considerations for Patients Receiving HMG–CoA Reductase Inhibitors (Statins): Evaluation 18. A client diagnosed with hyperlipidemia has been taking atorvastatin for several months. How can the therapeutic effect of the medication be determined? A) assessing the client’s resting heart rate and postural blood pressures B) reviewing the client’s laboratory blood work results C) assessing the client’s exercise tolerance and activities of daily living D) performing a focused cardiac assessment

Ans: B

Feedback: The benefits of lipid-lowering agents are frequently not perceived by the client and do not often change the client’s day-to-day cardiac function or activity level. They are most often assessed by reviewing the client’s cholesterol levels.

Format: Multiple Selection Chapter: 47 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 829, Risk Factors for Atherosclerotic Cardiovascular Disease, Box 47.1 19. The client receives a prescription for a lipid-lowering medication from the primary health care provider. The nurse knows additional lifestyle modifications would enhance the management of the client’s lipid levels. What recommendations should the nurse make? Select all that apply. A) quitting smoking B) exercising regularly C) following a low-sodium diet D) reducing stress E) abstaining from alcohol

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F) increasing fluid intake

Ans: A, B, D

Feedback: Lifestyle changes including low-fat diet, exercise, smoking cessation, and stress reduction should be tried before any antihyperlipidemic drug is used. Avoiding alcohol is not indicated as a means to lower serum lipid levels, though excessive intake can cause adverse effects of lipid-lowering therapy. Although a low-sodium diet is a healthy choice, it is not associated with elevating lipid levels. Increasing fluid intake does not have an effect on managing lipid levels.

Format: Multiple Choice Chapter: 47 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 828, Atherosclerotic Cardiovascular Disease 20. A client is diagnosed as having an elevated cholesterol level. The nurse is aware that plaque on the inner lumen of arteries begins as what? A) fatty streaks B) white blood cells (WBCs) C) foam cells D) platelets and fibrin

Ans: A Feedback: Coronary artery disease is characterized by the progressive growth of atheromatous plaques, or atheromas, in the coronary arteries. These plaques, which begin as fatty streaks in the endothelium, eventually injure the endothelial lining of the artery, causing an inflammatory reaction. This inflammatory process triggers the development of characteristic foam cells, containing fats and WBCs that further injure

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the endothelial lining. Over time, platelets, fibrin, other fats, and remnants collect on the injured vessel lining and cause the atheroma to grow, further narrowing the interior of the blood vessel and limiting blood flow.

Format: Multiple Choice Chapter: 47 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 831, Fats and Biotransformation (Metabolism): Lipoproteins 21. The nurse is teaching a 45-year-old client about ways to lower cholesterol level. What effects of exercise does the nurse describe on high-density lipoproteins (HDLs) and low-density lipoproteins (LDLs)? A) increases HDLs and decreases LDL B) increases LDL and decreases triglycerides C) decreases HDL and increases LDL D) decreases both HDL and LDL

Ans: A

Feedback: Moderate exercise increases HDL levels, which assist in lowering LDL levels. Exercise also decreases triglyceride levels.

Format: Multiple Choice Chapter: 47 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning

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Objective: 1, 5 Page and Header: 829, Risk Factors for Atherosclerotic Cardiovascular Disease, Box 47.1 22. The nurse teaches a client at risk for coronary artery disease (CAD) that some risk factors can be controlled or modified. What modifiable factors would the nurse include? A) gender, obesity, family history, and smoking B) inactivity, stress, gender, and smoking C) obesity, inactivity, diet, and smoking D) stress, family history, and obesity

Ans: C

Feedback: The risk factors for CAD that can be controlled or modified include obesity, inactivity, diet, stress, and smoking. Gender and family history are risk factors that cannot be controlled.

Format: Multiple Choice Chapter: 47 Client Needs: Health Promotion and Maintenance Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 831, Fats and Biotransformation (Metabolism): Lipoproteins 23. The nurse is caring for a client who has been diagnosed with high serum cholesterol and triglyceride levels. In teaching the client about therapeutic lifestyle changes and the use of medications, the nurse explains the desired goal for cholesterol levels is what? A) increased high-density lipoprotein (HDL) values and increased triglyceride values B) 1:1:1 ratio of low-density lipoprotein (LDL), HDL, and total cholesterol C) elevated blood lipids and fasting glucose less than 5.6 mmol/L (100 mg/dL) D) reduced LDL values and increased HDL values

Ans: D

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Feedback: The desired goal for cholesterol readings is for a client to have low LDL and high HDL values. Consequently, a 1:1:1 ratio of LDL, HDL, and total cholesterol would not be desirable. HDL serves as a protective mechanism to reduce cholesterol, so higher levels are desirable. Elevated blood lipids are never desirable, but control of blood sugar levels reduces CAD risk.

Format: Multiple Selection Chapter: 47 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1, 5 Page and Header: 829, Risk Factors for Atherosclerotic Cardiovascular Disease, Table 47.1 24. The nurse is teaching a client how to reduce risk for coronary artery disease (CAD). What should the nurse recommend? Select all that apply. A) lose weight B) manage hypertension C) eat a high-protein, low-carbohydrate diet D) increase intake of foods high in antioxidants E) reduce stress levels whenever possible

Ans: A, B, E

Feedback: Successful treatment in reducing risk for CAD involves reducing risk factors including decreasing dietary fats (decreasing total fat intake and limiting saturated fats seems to have the most impact on serum lipid levels); losing weight, which helps to decrease insulin resistance and the development of type 2 diabetes; eliminating smoking; increasing exercise levels; decreasing stress; and treating hypertension, diabetes, and gout. Increased protein intake is not recommended; many high-protein

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foods are also high in fat, and there is no benefit to increased protein. Similarly, foods considered to be high in antioxidants are not of any proven benefit.

Format: Multiple Choice Chapter: 47 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 834, Focus on Drug Therapy Across the Lifespan: Lipid-Lowering Agents: Children, Box 47.4 25. The nurse cares for a 10-year-old client who has been diagnosed with hypercholesterolemia. What is the most common cause of hypercholesterolemia in pediatric clients? A) gender B) diet C) familial connection D) sedentary lifestyle Ans: C

Feedback: Familial hypercholesterolemia may be seen in pediatric clients. Because of the importance of lipids in the developing nervous system, treatment is usually restricted to tight dietary restrictions to limit fats and calories. Gender, diet, or exercise-resistant hypercholesterolemia is possible in children, but they are not the most common causes.

Format: Multiple Selection Chapter: 47 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 1, 5 Page and Header: 829, Risk Factors for Atherosclerotic Cardiovascular Disease, Box 47.1 26. The nurse provides client teaching related to medication and lifestyle changes the client can make to reduce serum lipid levels. One month later, the nurse evaluates the client teaching as having been effective based on what data? Select all that apply. A) decreased total cholesterol level B) decreased high-density lipoprotein (HDL) C) decreased low-density lipoprotein (LDL) D) blood pressure 118/28 mmHg E) weight loss of 8 lb (3.6 kg)

Ans: A, C, D, E

Feedback: For most clients, desirable outcomes include increased HDL, decreased LDL, and decreased total cholesterol. Weight loss and blood pressure control are also positive outcomes.

Format: Multiple Choice Chapter: 47 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 842, HMG–CoA Reductase Inhibitors (Statins): Nursing Considerations for Patients Receiving HMG–CoA Reductase Inhibitors (Statins): Intervention with Rationale 27. The nurse is caring for a 35-year-old female client who is taking a beta-hydroxybeta-methylglutaryl–coenzyme A (HMG–CoA) reductase inhibitor to lower serum lipid levels. When teaching this client about the medication, what priority teaching point will the nurse include?

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A) need for frequent ophthalmic examinations B) information about a cholesterol-lowering diet C) use of barrier contraceptives D) notifying the primary health care provider of respiratory symptoms

Ans: C

Feedback: It is important to teach a female client of childbearing age taking HMG–CoA reductase inhibitors to use barrier contraceptives because there is a risk of severe fetal abnormalities associated with these drugs if taken during pregnancy. Both male and female clients should have routine ophthalmic examinations, but taking this drug does not increase the frequency of examinations needed. Cholesterol-lowering diet should have been initiated before beginning medications to lower lipid levels. There are no associated respiratory risks with these medications, so the client would call the primary health care provider with respiratory symptoms as one normally would.

Format: Multiple Selection Chapter: 47 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 841, HMG–CoA Reductase Inhibitors (Statins): Nursing Considerations for Patients Receiving HMG–CoA Reductase Inhibitors (Statins): Assessment: History and Examination 28. When providing client teaching to a client beginning therapy with a hydroxymethylglutaryl–coenzyme A (HMG–CoA) reductase inhibitor, the nurse will explain the need for regular monitoring of what laboratory studies? Select all that apply. A) renal function tests B) liver function tests C) lipid panel

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D) hemoccult of stool E) albumin level

Ans: A, B, C

Feedback: It is important to monitor renal and liver function to identify early signs of toxicity or rhabdomyolysis. Monitoring lipid levels contributes to evaluation of the effectiveness of drug therapy. Hemoccult of stool would be more important with bile acid sequestrants that are associated with GI irritation. Altered albumin levels are not associated with HMG–CoA reductase inhibitors. Format: Multiple Choice Chapter: 47 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 834, Bile Acid Sequestrants: Adverse Effects 29. The nurse is preparing to teach a client about diet therapy when beginning bile sequestrant medication to lower lipid levels. What important point will the nurse include in the teaching plan? A) increasing carbohydrate intake B) reducing protein intake C) increasing fiber intake D) reducing fluid intake

Ans: C

Feedback: The nurse would want to teach this client to increase fiber intake to avoid constipation that often occurs with this medication. Protein intake does not need to be reduced, but the client should be taught to avoid fatty protein and instead meet protein needs with vegetable proteins, fish, and lean poultry. Carbohydrate intake should be reduced if weight loss is needed, otherwise no change is needed. Fluid intake should be

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maintained or increased if there are no diagnoses that would contraindicate fluid intake to help avoid constipation.

Format: Multiple Choice Chapter: 47 Client Needs: Physiological Integrity: Reduction of risk potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 829, Focus on Cultural Considerations, Box 47.2 30. A 50-year-old female client expresses concern about developing atherosclerotic cardiovascular disease (ASCVD). What statement made by the client suggests an understanding of the information the nurse presented on minimizing the risk? A) “If I stop smoking today, I will significantly reduce my lifetime risk of developing ASCVD.” B) “It’s comforting to know that the risk for ASCVD is less for woman of my age than it is for men.” C) “Loosing those 25 lb (11.4 kg) and keeping it off for the last 10 years has done a lot to minimize my risk.” D) “I’ve smoked since I was a teenager, but I never smoked more than a ½ pack a day, so my risk isn’t that great.”

Ans: C

Feedback: Obesity increases the heart’s workload contributes to the risk of developing ASCVD. Being within the normal weight range for height will help minimize the client’s risk. The risk of ASCVD is related to the duration and amount of smoking. The client’s years and amount of smoking pose a significant risk. Cessation of smoking reduces risk immediately, but it may take 20 years or more to completely reverse the risk. Males are more likely than premenopausal females to have ASCVD; however, the incidence is

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almost equal in males and postmenopausal females, possibly because of a protective effect of estrogens.

Format: Multiple Choice Chapter: 47 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 829, Focus on Cultural Considerations, Box 47.2 31. The nurse is managing care for four clients who have been diagnosed with hyperlipidemia. Which client is priority for the nurse to monitor for a lack of proper medication adherence? A) an older Hispanic client prescribed simvastatin B) a middle-aged client of East Asian descent prescribed lovastatin C) a Pakistan college exchange student prescribed fluvastatin D) a native American teenager prescribed fenofibrate

Ans: B

Feedback: People of East Asian descent may have increased sensitivity to statins. This increases the risk of a lack of adherence to the prescribed therapy. While each of the other clients have a general increased risk for elevated cholesterol and thus atherosclerotic cardiovascular disease (ASCVD), none have a cultural characteristic that would present a barrier to medication adherence.

Format: Multiple Choice Chapter: 47 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply

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Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 829, Risk Factors for Atherosclerotic Cardiovascular Disease, Box 47.1 32. The nurse recognizes that which client presents with an increased risk for the development of atherosclerotic cardiovascular disease (ASCVD)? A) an older adult client with a history of anoxia nervosa B) a sexually active adult client who does not use condoms for birth control C) a client whose parent died of ASCVD at the age of 67 D) a premenopausal female client diagnosed with endometriosis

Ans: B

Feedback: A sexually active adult not relying on a barrier method of birth control, such as condoms, is at risk for the development of chlamydia. Chlamydia is a bacterial infection that has shown to be a possible trigger for ASCVD if left untreated. Obesity rather than being underweight is a modifiable factor for ASCVD. Unmodifiable risk factors include a direct family history of ASCVD that resulted in death prior to age 55. The incidence of ASCVD increases after menopause regardless of a diagnosis of endometriosis.

Test Generator Questions, Chapter 48, Drugs Affecting Blood Coagulation Format: Multiple Choice Chapter: 48 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5

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Page and Header: 867, Focus on Safe Medication Administration, Box 48.5 1. A client is admitted to the hospital with deep vein thrombosis (DVT). An infusion of heparin is established. What nursing action best protects the client’s safety? A) Ensure that the client’s call light is easily accessible. B) Have two nurses independently monitor the client’s heparin infusion. C) Ensure that protamine sulfate is readily available. D) Keep a preloaded syringe of vitamin K in the room.

Ans: C

Feedback: The antidote for heparin is protamine sulfate, and it is prudent to have this on hand if a client is receiving an infusion of heparin. Vitamin K reverses the effect of warfarin. The administration of heparin must be established and monitored carefully, but it is not usual practice for two nurses to maintain the infusion independent of one another and could lead to errors and omissions. Clients’ call lights should always be available, but this is less significant than ensuring the availability of the antidote.

Format: Multiple Choice Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 867, Nursing Considerations for Patients Receiving Anticoagulants: Assessment: History and Examination 2. The nurse is assessing a client who is being considered for anticoagulant therapy. What aspect of the client’s health history should the nurse follow up most closely? A) The client’s last menstrual period was 10 days ago. B) The client has a history of gastrointestinal (GI) ulcers. C) The client has a history of recurrent urinary tract infections. D) The client’s current body mass index is 32.

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Ans: B

Feedback: Beginning anticoagulant therapy with active GI ulcers could result in severe bleeding. The date of this client’s last menstrual period presents no obvious safety risk. Recurrent urinary tract infections and obesity should not impact anticoagulant therapy.

Format: Multiple Choice Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 867, Nursing Considerations for Patients Receiving Anticoagulants: Assessment: History and Examination 3. The nurse is caring for a female client who is breastfeeding her 3-month-old infant. What will the nurse instruct the client to do prior to starting heparin to treat venous thrombosis? A) “Wait an hour after taking the anticoagulant before breastfeeding your infant.” B) “Drink ample amounts of fluids to clear the drug from your system before breastfeeding your infant.” C) “You will need to stop breastfeeding your infant and provide formula to your infant while taking this drug.” D) “You can continue breastfeeding because heparin does not enter your breast milk.”

Ans: D

Feedback: Although some adverse fetal effects have been reported with its use during pregnancy, heparin does not enter breast milk, and so it is the anticoagulant of choice if one is needed during lactation. As a result, there is no need to wait an hour, increase fluid intake, or find another method of feeding the infant.

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Format: Multiple Choice Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 868, Nursing Considerations for Patients Receiving Anticoagulants: Interventions with Rationale 4. The nurse is caring for a client who is having an acute myocardial infarction (MI) in the emergency department. What drug will the nurse administer before admitting the client to a unit in the hospital? A) anagrelide B) clopidogrel C) ticlopidine D) tenecteplase

Ans: D

Feedback: Arrange to administer tissue plasminogen activators to reduce mortality associated with acute MI as soon as possible after the onset of symptoms because the timing for the administration of tenecteplase is critical to resolve the clot before permanent damage occurs to the myocardial cells. Anagrelide is used to treat essential thrombocytopenia. Clopidogrel is used to treat clients who are at risk for ischemic events; ticlopidine is used to reduce the risk of thrombotic stroke.

Format: Multiple Choice Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 867, Anticoagulants: Clinically Important Drug–Drug Interactions 5. A nurse is preparing to discharge a client who has been prescribed warfarin. While assessing the client’s knowledge of the drug, what statement by the client should the nurse address? A) “I take vitamin C when I feel like I’m getting a cold.” B) “I take aspirin to help with the pain of my arthritis.” C) “My plan following discharge is to walk 2 miles a day.” D) “I drink a glass of wine with dinner some evenings.”

Ans: B

Feedback: Increased bleeding can occur if a salicylate is taken in combination with warfarin. The nurse will instruct the client to stop taking aspirin. Walking, taking vitamin C, and drinking an occasional glass of wine should not interfere with the therapeutic effects of warfarin.

Format: Multiple Choice Chapter: 48 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 1, 3 Page and Header: 864, Anticoagulants: Contraindications and Cautions 6. The nurse is caring for a client with a fever and severe diarrhea in addition to thrombophlebitis. How will this client’s condition impact the clotting process? A) depleted production of Hageman factor B) increased production of thrombin C) activation of plasminogen

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D) reduced production of fibrinolysin

Ans: C

Feedback: Plasminogen is the basis for the clot-dissolving system. It is converted to plasmin (fibrinolysin) by several factors including Hageman factor, which is factor XII found in circulating blood. Activated thrombin breaks down fibrinogen to form fibrin threads, which form a clot inside the blood vessel. Clients with diarrhea or fever could alter the normal clotting process by, respectively, loss of vitamin K from the intestine or activation of plasminogen.

Format: Multiple Choice Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 868, Nursing Considerations for Patients Receiving Anticoagulants: Interventions with Rationale 7. A client has been diagnosed with atrial fibrillation and has begun warfarin therapy. The nurse has checked the client’s most recent laboratory values. What finding best suggests that the drug is having the desired effect? A) The client’s platelet count is 199 ×109/L (199 ×103/µL). B) The client’s heart rate is 82 beats/min with normal sinus rhythm. C) The client’s international normalized ratio (INR) is 2.7. D) The client’s plasminogen level is 1.9 µmol/L (16.8 mg/dL).

Ans: C

Feedback: The therapeutic effects of warfarin are primarily determined on the basis of the client’s INR, which is expected to range between 2.0 and 3.0. Prothrombin time is

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also clinically significant. Each of the other listed values is within reference ranges, but none are used to determine the effectiveness of warfarin therapy.

Format: Multiple Choice Chapter: 48 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 861, Focus on Herbal and Alternative Therapies, Box 48.2 8. A client is being discharged home on warfarin. The discharge teaching by the nurse should include a warning to avoid which herbal supplement? A) St. John’s wort B) tarragon C) ginkgo D) saw palmetto

Ans: C

Feedback: Many of the herbal remedies are known to alter blood coagulation and should be avoided when taking anticoagulants. Clients taking these drugs should be cautioned to avoid angelica, cat’s claw, chamomile, chondroitin, feverfew, garlic, ginkgo, goldenseal, grape seed extract, green leaf tea, horse chestnut seed, psyllium, and turmeric. If a client who is taking an anticoagulant presents with increased bleeding and no other interaction or cause is found, question the client about the possibility of use of herbal therapies. St. John’s wort, tarragon, and saw palmetto are not implicated as having an interaction with anticoagulants.

Format: Multiple Choice Chapter: 48

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3 Page and Header: 857, Drugs Affecting Clot Formation and Resolution: Antiplatelet Agents 9. The nurse administers clopidogrel appropriately to the client for what purpose? A) maintaining the patency of grafts B) treating peripheral artery disease C) preventing emboli from valve replacements D) dissolving a pulmonary embolus and improving oxygenation

Ans: B

Feedback: Clopidogrel is used to inhibit platelet aggregation, decreasing the formation of clots in narrowed or injured blood vessels like those found in peripheral artery disease. Maintaining the patency of grafts or preventing emboli from valve replacements would be accomplished using an anticoagulant. Dissolving emboli would be accomplished using streptokinase or a similar enzyme to stimulate the conversion of plasminogen to plasmin.

Format: Multiple Choice Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 865, Nursing Care Guide for G.R.: Warfarin-Assessment: History and Examination

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10. The nurse is caring for a client who is going home on warfarin. What laboratory test will the nurse inform the client will be used to evaluate therapeutic effects of the drug? A) activated partial thromboplastin time (APTT) B) platelet levels C) prothrombin time (PT) and international normalized ratio (INR) D) prothrombin time (PT) and activated partial thromboplastin time (APTT)

Ans: C

Feedback: PT and INR are ordered to evaluate for therapeutic effects of warfarin. Normal values of PT is 1.3 to 1.5 times the control value, and the ratio of PT to INR is 2 to 3.5. The other tests do not evaluate the therapeutic effects of warfarin.

Format: Multiple Selection Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 3 Page and Header: 857, Drugs Affecting Clot Formation and Resolution: Antiplatelet Agents 11. What drugs would the nurse administer to a client needing antiplatelet effects? Select all that apply. A) ticlopidine B) desirudin C) fondaparinux D) abciximab E) alteplase

Ans: A, D

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Feedback: Antiplatelet agents available for use include abciximab, anagrelide, aspirin, cilostazol, clopidogrel, dipyridamole, eptifibatide, ticlopidine, ticagrelor, and tirofiban. Desirudin and fondaparinux are anticoagulants, and alteplase is a thrombolytic agent.

Format: Multiple Choice Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 868, Nursing Considerations for Patients Receiving Anticoagulants: Intervention with Rationale 12. A client is receiving subcutaneous heparin 5,000 units every 8 hours. An activated thromboplastin time (aPTT) is drawn 1 hour before the 0800 dose. The results show that the aPTT is at 3.5 times the control value. What is the nurse’s priority action? A) Give a dose larger than is prescribed to the client. B) Give the dose as prescribed and chart the results. C) Check the client’s vital signs prior to administering the dose. D) Hold the dose and call the primary health care provider.

Ans: D

Feedback: The therapeutic level of heparin is demonstrated by an activated partial thromboplastin time (aPTT) that is 1.5 to 3 times the control value. The client’s value is 3.5 times control, which indicates clotting time is a bit too delayed and the dosage will likely either be reduced or a dosage may be held according to the order received from the physician. It would be inappropriate to give two doses at once, give the dose and chart the results, or simply check the vital signs without holding the dose and calling the primary health care provider.

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Format: Fill-in-the-Blank Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 858, Drugs in Focus: Drugs Affecting Clot Formation and Resolution, Table 48.1 13. A client has been diagnosed with heparin-induced thrombocythemia and been prescribed an intravenous infusion of argatroban 2 mcg/kg/min. The nurse has added 100 mg argatroban to a 100-mL Mini-Bag, and the client weighs 180.4 lb (82 kg). How much should the nurse administer to the client? Provide your answer to one decimal place.

Ans: 9.8 mL/h

Feedback: The first step is to determine the client’s dose in micrograms per minute, since that is the format of the prescription. The client weighs 82 kg, and 82 kg × 2 mcg = 164 mcg/min. Multiplying the dose by 60 yields the hourly dose: 9,840 mcg/h, or 9.84 mg/h. The drug is available at a concentration of 1 mg/mL (i.e., 100 mg in a 100-mL bag). Thus, the infusion should be run at 9.84 mL/h, which rounds to 9.8 mL/h.

Format: Multiple Choice Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 866, Focus on Safe Medication Administration, Box 48.4

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14. The nurse discovers a client receiving warfarin is bleeding. What drug should the nurse prepare to administer to this client? A) vitamin E B) vitamin K C) protamine sulfate D) calcium gluconate

Ans: B

Feedback: Injectable vitamin K is used to reverse the effects of warfarin. Protamine sulfate is used to reverse the effects of heparin. Vitamin E reduces effects of warfarin but is not used for that purpose. Calcium gluconate would not be indicated for this client.

Format: Multiple Choice Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 868, Nursing Considerations for Patients Receiving Anticoagulants: Interventions with Rationale 15. The nurse evaluates that additional client teaching is needed regarding anticoagulants when the client states which statement?” A) “I’ll start wearing a medical alert bracelet indicating my diagnosis.” B) “I plan to report to the laboratory for my follow-up blood work.” C) “I’ll use acetaminophen if I experience arthritis pain.” D) “I’ll use disposable razors to shave and use each razor only once.”

Ans: D

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Feedback: The client should use an electric razor to shave rather than a disposable razor that could nick the skin and increase the risk of bleeding. Wearing a medical alert bracelet, getting regular follow-up lab work, and use of acetaminophen would all be appropriate actions that would not indicate the need for further teaching.

Format: Multiple Choice Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 3, 5 Page and Header: 861, Focus on Herbal and Alternative Therapies, Box 48.2 16. The nurse determines teaching about warfarin is successful when the client makes what statement? A) “If I miss a dose one day, I will compensate by taking two pills the next day.” B) “I will check with my primary health care provider before taking any herbal supplements.” C) “I will minimize my physical activity, so I don’t start bleeding.” D) “I will make sure to get this annual flu vaccine this fall.”

Ans: B

Feedback: Warfarin is involved in many drug–drug and drug–herb interactions, so the client’s statement about checking with the doctor before starting any new drugs or supplements would be correct. The other statements made by the client indicate the need for further teaching. The client should not take two pills after missing a dose. The client should make an effort to avoid preventable injuries, but minimizing physical activity in general would not be necessary or beneficial. Vaccinations are beneficial but not to any greater extent than with a client who is not taking warfarin.

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Format: Multiple Selection Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 868, Nursing Considerations for Patients Receiving Anticoagulants: Interventions with Rationale 17. The nurse assesses blood in the urine of the 73-year-old client receiving warfarin this morning. What action will the nurse take? Select all that apply. A) Assess prothrombin time (PT). B) Assess international normalized ratio (INR). C) Expect to administer protamine sulfate. D) Expect to administer vitamin K. E) Assess partial thromboplastin time (PTT).

Ans: A, B, D

Feedback: Vitamin K is the antidote for warfarin. PT and INR are used to assess therapeutic levels of warfarin. PTT is used to assess therapeutic levels of heparin. Protamine sulfate is given as an antidote for heparin.

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18. The nurse is caring for a client following repeat coronary artery bypass grafting who has excessive bleeding. What systemic hemostatic drug will the nurse expect to administer? A) thrombin recombinant B) microfibrillar collagen C) human fibrin sealant D) aminocaproic acid

Ans: D

Feedback: The hemostatic drug that is used systemically is aminocaproic acid. Topical hemostatic agents include absorbable gelatin, human fibrin sealant, microfibrillar collagen, thrombin, and thrombin recombinant.

Format: Multiple Choice Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 863, Anticoagulants 19. A client is being sent home on enoxaparin following surgery. The nurse should describe what benefit of this medication? A) inhibiting the formation of clots B) stimulating production of certain clotting factors C) enhancing the flow of blood in peripheral vessels D) dissolving any clots that form

Ans: A

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Feedback: Low molecular weight heparins inhibit thrombus and clot formation by blocking factors Xa and IIa. Because of the size and nature of the molecules, these drugs do not greatly affect thrombin, clotting, or the PT; therefore, they cause fewer systemic adverse effects. Enoxaparin does not dissolve existing clots or directly enhance blood flow. It does not stimulate the production of clotting factors.

Format: Multiple Choice Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 868, Nursing Considerations for Patients Receiving Anticoagulants: Interventions with Rationale 20. What intervention does the nurse include in the plan of care for a client receiving a continuous intravenous (IV) infusion of heparin? A) avoiding intramuscular injections B) assessing for symptoms of respiratory depression C) measuring hourly urinary outputs D) monitoring blood pressure hourly

Ans: A

Feedback: The most commonly encountered adverse effect of the anticoagulants is bleeding, ranging from bleeding gums during toothbrushing to severe internal hemorrhage. Avoid all invasive procedures, including giving intramuscular (IM) injections, while the client is on heparin therapy. It would not be necessary to assess for respiratory depression, measure hourly output, or monitor the blood pressure hourly as related because of heparin administration.

Format: Multiple Selection

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Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 866, Patient Teaching for G.R. 21. The nurse is discharging a client who will remain on anticoagulant therapy. Which statement will the nurse include when teaching the client about taking this drug? Select all that apply. A) “Brush your teeth gently with soft bristle brush.” B) “Wear or carry a medical alert notification.” C) “Warning signs of bleeding include fatigue, pallor, and increased heart rate.” D) “Treat minor side effects with over-the-counter (OTC) medications.” E) “Obtain follow-up lab work regularly as ordered.”

Ans: A, B, C, E

Feedback: Clients should be taught to avoid bleeding risk by brushing teeth gently, using electric razors, and avoiding dangerous activities or falls that could cause bleeding. The client should have a medical alert bracelet, card, or identification of some kind with them at all times to notify other healthcare providers of anticoagulant therapy. Teach clients to recognize the signs of blood loss and stress the importance of follow-up lab work. Clients should be taught to avoid adding any new medication, prescription or OTC, without first talking to the primary health care provider to ensure safety.

Format: Multiple Selection Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 2, 4 Page and Header: 863, Anticoagulants: Therapeutic Actions and Indications 22. Which client would the nurse anticipate being prescribed heparin? Select all that apply. A) a client diagnosed with hemophilia B) for prevention of a pulmonary emboli in a client C) to treatment a client diagnosed with atrial fibrillation with embolization D) to treat a client diagnosed with a venous thrombosis E) a client diagnosed with disseminated intravascular coagulation (DIC)

Ans: B, C, D, E

Feedback: Indications include prevention and treatment of venous thrombosis and pulmonary emboli, treatment of atrial fibrillation with embolization, and diagnosis and treatment of DIC. Heparin is not given to clients with hemophilia because the drug would worsen bleeding.

Format: Multiple Choice Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 854, Focus on Drug Therapy Across the Lifespan: Drugs Affecting Blood Coagulation: Children, Box 48.1 23. The nurse is caring for a pediatric client who needs anticoagulation therapy. What drug will the nurse anticipate being prescribed for this client? A) heparin B) dabigatran C) rivaroxaban D) low molecular weight heparins

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Ans: A

Feedback: Heparin is approved for pediatric use. If heparin is used, the dosage should be carefully calculated based on weight and age. It should be verified by another registered nurse before the drug is administered. Dabigatran and rivaroxaban are not approved for use in pediatric clients. The safety of low molecular weight heparins has not been established in pediatric clients.

Format: Multiple Choice Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1, 2 Page and Header: 863, Anticoagulants: Therapeutic Actions and Indications 24. The nurse administers warfarin to a client. Which expected effect should the drug have on the body? A) decrease in production of vitamin K–dependent clotting factors B) increase in production of prothrombin C) increase in production of vitamin K–dependent factors in the liver D) increase in production of procoagulation factors

Ans: A

Feedback: Warfarin, an oral anticoagulant drug, causes a decrease in the production of vitamin K–dependent clotting factors in the liver. The eventual effect is a depletion of these clotting factors and a prolongation of clotting times. It is used to maintain a state of anticoagulation in situations in which the client is susceptible to potentially dangerous clot formation. It does not increase prothrombin, vitamin K–dependent factors in the liver, or procoagulation factors.

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Format: Multiple Choice Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 868, Thrombolytic Agents: Therapeutic Actions and Indications 25. A client presents to the emergency department with a new onset of unilateral weakness and visual disturbances. The primary health care provider prescribes suspects the client has had a cerebrovascular accident (CVA) and prescribes alteplase. What is the nurse’s priority prior to administering alteplase? A) asking the client to state any medication allergies B) assessing the client for a hemorrhagic stroke C) seeing if the client takes a beta-adrenergic blocker or aminoglycoside antibiotics D) reviewing the medical record to find the client’s blood type

Ans: B

Feedback: Administration of alteplase would exacerbate a hemorrhagic stroke by increase bleeding. For this reason, a hemorrhagic stroke must be ruled out. With regard to alteplase administration, this is a priority over the client’s allergy status or blood type. Beta-blockers and aminoglycosides do not contraindicate the use of alteplase. Format: Multiple Choice Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5

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Page and Header: 854, Focus on Drug Therapy Across the Lifespan: Drugs Affecting Blood Coagulation: Children, Box 48.1 26. A 3-year-old client is diagnosed with hemophilia A. The nurse is planning to provide discharge teaching to the client’s parents. Which information will the nurse include? A) the rationale for using aspirin rather than acetaminophen for mild pain B) strategies for preventing trauma or injury C) the necessity of daily vitamin K injections D) the need for weekly transfusions of packed red blood cells

Ans: B

Feedback: The prevention of trauma is important in clients with hemophilia due to the risk of bleeding. The client would require regular administration of clotting factors, not vitamin K or packed red cells. Aspirin could exacerbate the client’s risk for bleeding and places the pediatric client at risk for Reye’s syndrome.

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Ans: A

Feedback: Aminocaproic acid is associated with the development of hypercoagulation states if it is combined with oral contraceptives or estrogens. Oral contraceptives, in combination with aminocaproic acid or alone, do not increase the risk of pregnancy, bleeding, or infertility.

Format: Multiple Choice Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 857, Drugs Affecting Clot Formation and Resolution: Antiplatelet Agents 28. The client receives a new diagnosis of peripheral artery disease (PAD). The nurse anticipates an order for which medication? A) clopidogrel B) persantine C) aspirin D) warfarin

Ans: A

Feedback: Clopidogrel is indicated for the treatment of clients who are at risk for ischemic events; clients with a history of myocardial infarction, PAD, or ischemic stroke; and clients with acute coronary syndrome. Persantine, aspirin, and warfarin would not be indicated for this client. Persantine is blood thinner and vasodilator used to prevent blood clots. Aspirin is a nonsteroidal antiinflammatory drug (NSAID) and blood thinner used to treat pain, fever, headache, and inflammation and reduce the risk of a myocardial infarction. Warfarin is a blood thinner used to prevent and treat blood clots.

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Format: Multiple Choice Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 863, Anticoagulants: Therapeutic Actions and Indications 29. The nurse admits a client in acute respiratory distress secondary to pulmonary emboli. What drug will the nurse anticipate to be prescribed to lyse the clots? A) dabigatran B) tenecteplase C) rivaroxaban D) fondaparinux

Ans: A

Feedback: Dabigatran is used for lysis of pulmonary emboli and treatment of coronary thrombosis. Tenecteplase is used to reduce mortality associated with acute myocardial infarction. Rivaroxaban is used to prevent deep vein thromboses that may lead to pulmonary emboli. Fondaparinux is used to treat and prevent venous thromboembolic events.

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Page and Header: 864, Understanding Disseminated Intravascular Coagulation, Box 48.3 30. The nurse is caring for a client who has been diagnosed with disseminated intravascular coagulation (DIC). What is the drug of choice to treat this problem? A) heparin B) urokinase C) aspirin D) warfarin

Ans: A

Feedback: The treatment of choice for DIC is heparin, an anticoagulant. It prevents the clotting phase from being completed, thus inhibiting the breakdown of fibrinogen. It may also help avoid hemorrhage by preventing the body from depleting its entire store of coagulation factors. None of the other medications listed in this question are indicated for treatment of DIC and may, in fact, make the condition worse.

Format: Multiple Choice Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 871, Drugs in Focus: Drugs Used to Control Bleeding, Table 48.3 31. By what route will the nurse administer the antihemophilic agent to a client with hemophilia following a car accident? A) oral B) topical C) intravenous (IV) D) sublingual

Ans: C

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Feedback: All antihemophilic agents are administered IV and are not available for administration by any other route.

Format: Multiple Choice Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 870, Drugs Used to Control Bleeding 32. The nurse administers agents that control bleeding to clients diagnosed with hemophilia and what other condition? A) liver disease B) Lyme disease C) disseminated intravascular coagulation (DIC) D) pheochromocytoma

Ans: A

Feedback: Drugs to control bleeding are also given to clients with liver disease because liver disease prohibits clotting factors and proteins needed for clotting from being produced in adequate quantities. Lyme disease, DIC, and pheochromocytoma are not indications for administration of agents to control bleeding.

Format: Multiple Selection Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 872, Antihemophilic Agents: Adverse Effects 33. The nurse is caring for a pediatric client who has been diagnosed with hemophilia and receives antihemophilic factor several times a year. What should the nurse regularly screen this client for? Select all that apply. A) HIV B) hepatitis C) anemia D) infection E) cardiomyopathy

Ans: A, B, C

Feedback: The most common adverse effects associated with antihemophilic agents involve risks associated with the use of blood products (e.g., in a client with hepatitis or AIDS). Clients with hemophilia should also be monitored for anemia secondary to blood loss. There is no associated risk for infection or cardiomyopathy.

Format: Multiple Choice Chapter: 48 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 1, 3 Page and Header: 872, Antihemophilic Agents: Contraindications and Cautions 34. The nurse is caring for four clients, all diagnosed with hemophilia A and currently experiencing uncontrolled bleeding. The nurse would question administering factor VIIa to which client? A) a client also diagnosed with type 1 diabetes who has an active insulin pump B) a client who has developed antibodies against factor IX

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C) a pediatric client who is not responding to platelet transfusions D) a client being treated for hepatic encephalopathy

Ans: D

Feedback: Factor VIIa is used to treat and prevent bleeding in clients with hemophilia A or B who have formed antibodies against other clotting proteins. It not recommended for clients with liver disease as this may increase the risk of the client developing blood clots. It is also used in certain clients when platelet transfusion are not successful. Factor VIIa is safe to administer to clients receiving insulin as no known interactions exist. The medication can be administered to pediatric clients as studies have not shown reasons to limit the use.

Test Generator Questions, Chapter 49, Drugs Used to Treat Anemias Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 880, Anemia: Etiology of Anemia 1. The nurse is caring for a client whose diabetic nephropathy has resulted in anemia. What does the nurse expect is the cause of this client’s anemia? A) low serum iron levels B) low erythropoietin levels C) inadequate oxygenation of tissue D) lack of B12 and folic acid intake

Ans: B

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Feedback: Anemia can occur if erythropoietin levels are low. This is seen in association with renal failure, when the kidneys are no longer able to produce erythropoietin. Low iron levels, hypoxia, and vitamin deficiency are not likely to be the primary cause of anemia in a client with kidney failure.

Format: Fill-in-the-Blank Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 886, Drugs in Focus: Agents Used for Iron Deficiency Anemia, Table 49.2 2. A 2-year-old client weighing 32 lb (14.5 kg) is prescribed ferrous sulfate 6 mg/kg/d PO. How many milligrams will the nurse administer to the client per dose?

Ans: 87 mg

Feedback: The nurse will administer 87 mg per dose. The nurse will calculate the dose by multiplying weight times mg/kg/d or 14.5 × 6 = 87 mg.

Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 882, Focus on Drug Therapy Across the Lifespan: Drugs Used to Treat Anemias: Adults, Box 49.1

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3. The nurse is caring for a 28-year-old female client who has been diagnosed with renal failure. The client is prescribed epoetin alfa therapy for iron replacement. What assessment should the nurse prioritize before initiating therapy? A) weight B) last menstrual period C) intake and output for a 24-hour period D) blood type

Ans: B Feedback: The use of epoetin alfa is not recommended during pregnancy or lactation because of potential adverse effects to the fetus or baby. It is important to determine that the client is not pregnant before drug therapy has started, so the nurse would assess when the client last menstruated. The client’s weight, fluid balance, and blood type are less important factors in determining whether the drug can be used.

Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 885, Nursing Considerations for Patients Receiving ErythropoiesisStimulating Agents: Intervention with Rationale 4. The nurse improves client compliance with the drug regimen of epoetin alfa through what intervention? A) providing the client with an appointment card for each drug administration day B) helping the client set up a reminder system for days when the drug is to be administered C) arranging a referral for community transportation to come pick up the client from home

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D) having the client’s pharmacy contact the client on days when the drug should be administered

Ans: B

Feedback: The nurse should help the client establish a reminder system for when the dose is due. The pharmacy cannot be expected to perform this role, and having cards on hand does not provide an active reminder. The client can be taught to self-administer the drug, so there is no need for an appointment or arranging transportation.

Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 891, Nursing Considerations for Patients Receiving Iron Preparations: Intervention with Rationale 5. A client diagnosed with anemia and a severe gastrointestinal (GI) absorption disorder has been ordered iron dextran. What is most appropriate for the nurse to education the client about before administration of this drug? A) acute pain related to drug administration B) assessing the client’s knowledge of the diagnoses C) methods to prevent injury D) the potential of the drug to stain the teeth

Ans: A

Feedback: Iron dextran is a parenteral form of iron. It is given intramuscularly and must be given by the Z-track method. It can be very painful. Certainly, deficient knowledge and risk for injury related to central nervous system (CNS) effects are

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appropriate for this client but would not be priority over the immediate experience with medication administration. Because this medication is not given orally, tooth staining would not be a concern.

Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 888, Agents Used for Iron Deficiency Anemia: Clinically Important Drug–Food Interactions 6. A 22-year-old female client who has severe dysmenorrhea has been prescribed ferrous gluconate to treat iron deficiency anemia. What dietary guidelines should the nurse provide to the client? A) “Do not consume milk, coffee, or tea at the same time as your iron supplement.” B) “Avoid cured meats, shellfish, and aged cheeses while you’re taking iron supplements.” C) “Try to limit your intake of gluten while you are taking this supplement, so your body absorbs the iron better.” D) “Avoid drinking any grapefruit juice until you’re no longer taking iron supplements.”

Ans: A

Feedback: Iron is not absorbed if taken with antacids, eggs, milk, coffee, or tea. These substances should not be administered concurrently. None of the other listed foods and beverages are contraindicated.

Format: Multiple Choice Chapter: 49

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 894, Nursing Considerations for Patients Receiving Folic Acid Derivatives or Vitamin B12: Nursing Conclusions 7. The nurse develops a care plan for a client who has been prescribed a folic acid derivative that includes what priority nursing diagnosis? A) deficient knowledge regarding drug therapy B) risk for infection related to immunosuppression C) acute pain related to injection or nasal irritation D) risk for fluid volume imbalance related to cardiovascular effects

Ans: D

Feedback: Nursing diagnoses related to drug therapy might include risk for fluid volume imbalance related to cardiovascular effects. Deficient knowledge and acute pain might apply to this client, but the priority nursing diagnosis for this client is the risk for fluid imbalance related to cardiovascular effects. Folic acid derivatives do not create a risk for infection.

Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 884, Nursing Considerations for Patients Receiving ErythropoiesisStimulating Agents: Assessment: History and Examination

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8. During recovery from a gastrointestinal bleed, a client has been prescribed an iron preparation. Prior to beginning therapy, what assessment should the nurse prioritize? A) white cell differential B) hematocrit and hemoglobin C) aspartate aminotransferase levels D) serum creatinine levels

Ans: B

Feedback: Hematocrit and hemoglobin levels should be assessed before administration because the drug will be evaluated for effectiveness by the response of these levels to drug treatment. These levels are also used to determine dosage. Aspartate aminotransferase levels are associated with liver function, and serum creatinine levels are associated with renal function; neither of these are high priorities because iron supplements are not significantly hepatotoxic or nephrotoxic. The client’s white cell differential would not be affected unless an infection was present.

Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3 Page and Header: 882, Drugs in Focus: Erythropoiesis-Stimulating Agents, Table 49.1 9. What prescribed dosage for epoetin alfa would the nurse administer to a client without needing to clarify the order? A) 0.45 mcg/kg intramuscular once per week B) 1 mg/d intramuscular twice a week C) 100 mg/d orally each day D) 150 units/kg subcutaneously three times per week

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Ans: D

Feedback: An appropriate dosage of epoetin alfa is 50 to 100 units/kg intravenously (IV) or subcutaneously, 3 days a week. The medication is not administered intramuscular (IM). Darbepoetin alfa can be administered by IV or subcutaneously once a week, and the usual dose is 0.45 mcg/kg. Folic acid is administered orally, IM, subcutaneously, or IV; the usual dosage is 1 mg. The usual dose of ferrous sulfate is 100 to 200 mg/d orally.

Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 884, Erythropoiesis-Stimulating Agents: Adverse Effects 10. After assessing the client receiving erythropoietin drug therapy, the nurse suspects what finding is an adverse effect of erythropoietin drug therapy? A) The client has not had a bowel movement for 4 days. B) The client’s blood pressure is 102/59 mm Hg. C) The client has peripheral edema to the feet and lower legs. D) The client reports a “low, sad” mood.

Ans: C

Feedback: Potential adverse effects of an erythropoietin are edema, nausea, vomiting, chest pain, diarrhea, and hypertension. Changes in mood are not typically reported and would not likely be attributed directly to erythropoietin therapy.

Format: Multiple Choice

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Chapter: 49 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 881, Anemia: Megaloblastic Anemia: Vitamin B12 Deficiency 11. A 22-year-old female client with no significant health history reports severe fatigue. The client is found to be anemic as a result of vitamin B12 deficiency. What assessment question by the nurse best addresses a potential etiology? A) “How would you describe your menstrual periods?” B) “Do you eat any meat or animal products?” C) “Does anyone in your family have problems like this?” D) “Does your job involve exposure to any toxins?”

Ans: B

Feedback: Strict vegetarians who eat nothing but vegetables may develop a vitamin B12 deficiency. Heavy blood loss during menstruation can cause anemia, but this is unrelated to vitamin B12 deficiency. Family history is not a noted risk factor for this type of megaloblastic anemia. Toxins do not cause this particular vitamin deficiency.

Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 881, Anemia: Megaloblastic Anemia: Vitamin B12 Deficiency 12. A 50-year-old client with pernicious anemia asks the nurse, “Why can’t I just take a vitamin B12 pill instead of getting an injection?” What is the nurse’s best response?

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A) “Pernicious anemia is caused by your body’s inability to appropriately absorb vitamin B12.” B) “Oral ingestion of vitamin B12 irritates the gastrointestinal tract and bleeding could occur.” C) “Pernicious anemia alters mucous membrane lining of the bowel and impairs absorption.” D) “With severe deficiencies like yours, oral vitamin B12 does not work fast enough.”

Ans: A

Feedback: Vitamin B12 cannot be taken orally, because one problem with pernicious anemia is an inability by the client to absorb vitamin B12 due to low levels of intrinsic factor, not alteration of mucous membranes. This medication characteristic is unrelated to adverse effects, peak, and onset.

Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 887, Agents Used for Iron Deficiency Anemia: Adverse Effects 13. The nurse instructs a client taking oral iron preparations about strategies for addressing which potential adverse effect? A) clay-colored stools B) hypotension C) constipation D) frequent flatus

Ans: C

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Feedback: The most common adverse effects associated with oral iron supplements are related to direct gastrointestinal (GI) irritation (e.g., GI upset, anorexia, nausea, vomiting, diarrhea, dark stools, and constipation). Oral iron supplements do not cause hypotension, clay-colored stools, or frequent flatus.

Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 895, Agents for Hemolytic and Aplastic Anemias: Adverse Effects 14. The nurse is providing care for a client who has sickle cell anemia and who is being treated with hydroxyurea. When providing health education, what topic should the nurse prioritize? A) management of gastrointestinal irritation B) the importance of keeping immunizations up to date C) dietary sources of iron D) foods that are high in vitamin B12

Ans: A

Feedback: Hydroxyurea is cytotoxic and is associated with adverse effects associated with the death of cells, especially in cells that are rapidly turning over. Gastrointestinal (GI) effects include anorexia, nausea, vomiting, stomatitis, diarrhea, or constipation. Increased intake of vitamin B12 or iron does not relieve symptoms of sickle cell disease. Immunizations are important because infections can precipitate an acute crisis. However, for most clients, the immediate concern will be dealing with the varied and pervasive GI effects.

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Format: Multiple Selection Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 881, Erythropoiesis-Stimulating Agents 15. What drugs might the nurse administer to a client to stimulate the formation of red blood cells? Select all that apply. A) levoleucovorin B) hydroxocobalamin C) darbepoetin alfa D) methoxy polyethylene glycol-epoetin beta E) epoetin alfa

Ans: C, D, E

Feedback: Clients who are no longer able to produce enough erythropoietin in the kidneys may benefit from treatment with exogenous erythropoietin (EPO), which is available as the drugs epoetin alfa, darbepoetin alfa, and methoxy polyethylene glycolepoetin beta. Both darbepoetin alfa and methoxy polyethylene glycol-epoetin beta are approved to treat anemias associated with chronic renal failure, including clients receiving dialysis. Levoleucovorin and hydroxocobalamin are not erythropoiesisstimulating agents.

Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 1

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Page and Header: 881, Anemia: Etiology of Anemia: Hemolytic Anemia 16. The nurse is caring for four clients who have been diagnosed with anemia. Which client does the nurse classify as having a type of hemolytic anemia? A) iron deficiency anemia B) megaloblastic anemia C) pernicious anemia D) sickle cell anemia

Ans: D

Feedback: Another type of anemia is hemolytic anemia, which involves a lysing of red blood cells because of genetic factors or from exposure to toxins. Sickle cell anemia is a type of hemolytic anemia. Iron deficiency and megaloblastic anemias are different classifications of anemia.

Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 882, Drugs in Focus: Erythropoiesis-Stimulating Agents, Table 49.1 17. The nurse understands that which medication would best meet the needs of a client whose anemia is associated with chronic renal failure? A) methoxy polyethylene glycol-epoetin beta B) ferrous sulfate exsiccated C) levoleucovorin D) hydroxyurea

Ans: A

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Feedback: Both darbepoetin alfa and methoxy polyethylene glycol-epoetin beta are approved to treat forms of anemia associated with chronic renal failure, including in clients receiving dialysis. Ferrous sulfate exsiccated is used to treat iron deficiency. Levoleucovorin is administered to diminish toxicity and counteract the effects of impaired methotrexate elimination and of inadvertent overdose of folic acid antagonists after high-dose methotrexate therapy for osteosarcoma. Hydroxyurea is used to reduce the frequency of painful sickle cell crises and to decrease the need for blood transfusions in adults with sickle cell anemia.

Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1, 2 Page and Header: 881, Anemia: Megaloblastic Anemia: Vitamin B12 Deficiency 18. What will the nurse caring for a client who has been diagnosed with pernicious anemia anticipate the client will require? A) iron supplements B) vitamin B12 C) erythropoietin D) hydroxyurea

Ans: B

Feedback: Pernicious anemia occurs when the gastric mucosa cannot produce intrinsic factor and vitamin B12 cannot be absorbed. Iron, erythropoietin, and hydroxyurea will not compensate for this specific deficiency.

Format: Multiple Choice

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Chapter: 49 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 1, 5 Page and Header: 880, Anemia: Etiology of Anemia 19. The nurse is caring for a hospitalized client who has been diagnosed with sickle cell anemia. What action should the nurse perform to reduce the client’s likelihood of a sickle cell crisis? A) Adhere closely to standard precautions. B) Limit the client’s fluid intake. C) Maintain a cool temperature in the client’s room. D) Ensure that the client is turned every 2 hours.

Ans: A

Feedback: Sickle cell crisis can be precipitated by infections, and the nurse should take action to ensure that infection control measures are adhered to. Fluid imbalances and cool temperatures would be a cause for a sickle cell crisis. Turning is only necessary if a client is wholly immobile and has minimal bearing on a client’s risk for infection. Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 887, Agents Used for Iron Deficiency Anemia: Adverse Effects 20. The nurse is caring for a client who had a postpartum hemorrhage 2 weeks ago that resulted in anemia. The client has called the clinic after passing dark stools, stating, “I looked this up online, and I’m worried I might have stomach or intestinal bleeding.” What is the nurse’s best initial action?

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A) See if the client was treated with erythropoietin. B) Ask how much blood the client lost postpartum. C) Assess the client’s usual bowel pattern. D) Determine if the client is taking iron supplements.

Ans: D

Feedback: Iron supplements often cause black, tarry stool. This does not mean that the client should not be assessed further, but this is the most likely question to ask initially. The quantity of the client’s blood loss postpartum is not a priority. The client would not have required erythropoietin for a hemorrhage. It is not a high priority to ask about the client’s usual bowel pattern; the client has already indicated that this is a significant deviation.

Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 3 Page and Header: 883, Erythropoiesis-Stimulating Agents: Contraindications and Cautions 21. A client has been prescribed epoetin alfa. What assessment finding may suggest to the nurse that the drug is contraindicated for this client? A) The client takes bupropion for the treatment of depression. B) The client frequently has loose stools. C) The client’s blood pressure is 161/107 mm Hg. D) The client is short of breath on exertion.

Ans: C

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Feedback: Erythropoiesis-stimulating agents are contraindicated in the presence of uncontrolled hypertension because of the risk of worsening hypertension when red blood cell counts increase and the pressure within the vascular system also increases. There is no contraindication to the use of erythropoiesis-stimulating agents for clients with chronic or acute diarrhea or activity intolerance or who take antidepressants.

Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 881, Anemias: Megaloblastic Anemia: Vitamin B12 Deficiency 22. An older adult client, diagnosed with pernicious anemia, asks the nurse what causes this disorder. The nurse’s response would indicate that there is a lack of intrinsic factor secreted needed for absorption of vitamin B12 where? A) large bowel B) lower esophagus C) stomach D) small bowel

Ans: D

Feedback: Intrinsic factor, also secreted by the gastric mucosa, combines with dietary vitamin B12 so that the vitamin can be absorbed in the ileum, located in the small bowel. Other options are incorrect.

Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Reduction of Risk Potential

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Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 881, Anemia: Hemolytic Anemia: Sickle Cell Disease 23. The nurse is caring for clients who have been diagnosed with anemia. The nurse knows that what form of anemia is a result of a genetic carrier? A) renal failure B) sickle cell anemia C) iron deficiency anemia D) vitamin B12 deficiency

Ans: B

Feedback: Hemolytic anemia can be either inherited or acquired. Two types of inherited hemolytic anemias that warrant further discussion are from sickle cell disease and thalassemia. The other answers are incorrect because these are not genetic in nature.

Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 882, Focus on Drug Therapy Across the Lifespan: Drugs Used to Treat Anemias: Children, Box 49.1 24. The nurse is caring for a pediatric client who has been prescribed supplemental iron therapy in liquid form. What is the priority parent teaching to be provided by the nurse? A) The iron should be taken through a straw. B) Positive results from treatment will be seen in 1 to 2 weeks. C) Results will be evaluated through the client’s appearance.

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D) Dosages are determined by serum iron levels.

Ans: A

Feedback: Iron doses for replacement therapy are determined by age. If a liquid solution is being used, the client should drink it through a straw to avoid staining the teeth. Periodic blood counts should be performed, the results of which will determine the success of therapy; it may take 4 to 6 months of oral therapy to reverse an iron deficiency.

Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 4 Page and Header: 892, Drugs in Focus: Agents Used for Other Anemias, Table 49.3 25. The nurse admits a 26-year-old client who has been diagnosed with sickle cell anemia. What drug will the nurse anticipate administering to the client? A) hydroxyurea B) methoxy polyethylene glycol-epoetin beta C) vitamin B12 D) leucovorin

Ans: A

Feedback: Indications for use of hydroxyurea include reducing the frequency of painful crises and the need for blood transfusions in adult clients with sickle cell anemia. The other options would not be used to treat a client with sickle cell anemia.

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Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3 Page and Header: 889, Critical Thinking Scenario: Iron Preparations and Toxicity: Discussion 26. The nurse admits a client to the pediatric unit who has an abnormally high serum iron level after eating a family member’s supplements. What intervention will the nurse perform? A) Obtain a blood sample for type and cross-match. B) Administer deferoxamine as prescribed. C) Monitor the client for changes in bowel function. D) Administer hydroxyurea as prescribed.

Ans: B

Feedback: Deferoxamine is given intramuscular, intravenous, or subcutaneously to treat elevated iron levels. Hydroxyurea treats sickle cell anemia, not iron overdose. There is no obvious indication that a blood transfusion will be necessary, so type and cross-match is not a high priority. Bowel function is a lower priority than administering a chelating agent.

Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 2

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Page and Header: 882, Drugs in Focus: Erythropoiesis-Stimulating Agents, Table 49.1. 27. The nurse is caring for a client who has been newly diagnosed with cancer. The client tells the nurse, “I saw advertisements on epoetin alfa and I want to start taking it immediately so I don’t get tired from chemotherapy.” What is the nurse’s best response? A) “Epoetin alfa is only effective if you develop anemia from chemotherapy that is caused by low levels of erythropoietin.” B) “Being anemic is a requirement for this medication, so I will draw some blood for lab work while you’re here.” C) “Chemotherapy causes anemia and only when that happens will it be appropriate to prescribe epoetin alfa for you.” D) “The primary health care provider may order epoetin alfa for you when it is appropriate, but now is not the time.”

Ans: A

Feedback: There is a risk of decreasing normal levels of erythropoietin if epoetin alfa, or any of this classification of drug (erythropoiesis-stimulating agents), is given to clients who have normal renal functioning and adequate levels of erythropoietin. The client should be taught that the drug will only be prescribed if the client develops anemia due to inadequate erythropoietin. Although it is true the primary health care provider may prescribe the drug when it is appropriate, this answer does not explain why it is inappropriate to prescribe it now. Anemia alone is not sufficient cause for prescribing epoetin alfa, and not all chemotherapy results in anemia.

Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 3, 4

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Page and Header: 894, Agents Used for Other Anemias: Agents for Hemolytic and Aplastic Anemias 28. What drug might the nurse administer to a client who has been diagnosed with anemia as an antineoplastic drug because it is cytotoxic? A) epoetin alfa B) ferrous sulfate C) hydroxocobalamin D) hydroxyurea

Ans: D

Feedback: Hydroxyurea is a cytotoxic antineoplastic drug that is also used to treat leukemia, ovarian cancer, and melanoma. The other options would not serve this purpose.

Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 891, Agents for Megaloblastic Anemias 29. The nurse is caring for a client who has been diagnosed with a megaloblastic anemia and administers what drug? A) folic acid B) hydroxyurea C) ferrous sulfate D) epoetin alfa

Ans: A

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Feedback: Folic acid and vitamin B12 are given as replacement therapy for dietary deficiencies, as replacement in high-demand conditions such as pregnancy and lactation, and to treat megaloblastic anemia. Hydroxyurea is used to treat sickle cell anemia. Ferrous sulfate is indicated for the treatment of iron deficiency anemia. Epoetin alfa is administered to treat anemias caused by inadequate erythropoietin production, such as in renal failure.

Format: Multiple Selection Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 2 Page and Header: 893, Agents for Megaloblastic Anemias: Adverse Effects 30. The nurse is preparing the client prescribed hydroxocobalamin for discharge and teaches the client to be alert for what adverse effect? Select all that apply. A) itching B) peripheral edema C) hypotension D) heart failure E) constipation

Ans: A, B, D

Feedback: Hydroxocobalamin has been associated with itching, rash, and signs of excessive vitamin B12 levels, which can also include peripheral edema and heart failure. Hypotension and constipation are not adverse effects of hydroxocobalamin therapy.

Format: Multiple Choice Chapter: 49

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 884, Focus on Safe Medication Administration, Box 49.3 31. The client has taken epoetin alfa with good results for several months. On this visit, the nurse analyzes the client’s lab results and finds indications of severe anemia and cytopenias. What prescription will the nurse anticipate receiving? A) Increase the dosage of epoetin alfa. B) Change the client to another erythropoiesis-stimulating agent. C) Discontinue the use of epoetin alfa. D) Begin administering epoetin alfa intravenously instead of subcutaneously.

Ans: C

Feedback: In clients treated with epoetin alfa or any drug in this class who develop severe anemia after improvement, the drug should be stopped and should not be changed to another drug in the class because it is likely due to client’s development of neutralizing antibodies. Increasing the dosage will not help, and changing the route of administration will not reverse the process after antibodies have formed.

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32. The client on hemodialysis is receiving epoetin alfa and asks the nurse why intravenous (IV) administration is recommended over subcutaneous administration. What is the nurse’s best response? A) “Giving the drug IV reduces risk of a potentially serious response.” B) “Giving the drug by the IV route makes it begin working sooner.” C) “Only clients with renal disease can receive the drug subcutaneously.” D) “It is based on your primary health care provider’s personal route preference.”

Ans: A

Feedback: It is now recommended that clients on hemodialysis receive epoetin alfa and other drugs in this classification intravenously rather than subcutaneously because this reduces the risk of antibody production that can result from severe anemia. This decision is not based on speed of onset, diagnosis, or primary health care provider’s preference.

Format: Multiple Choice Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 884, Focus on Safe Medication Administration, Box 49.3 33. The nurse is administering an erythropoiesis-stimulating agent to a client with renal failure and anemia. What is the maximum hemoglobin level the nurse would want to assess when reviewing this client’s lab results? A) 7 g/dL (4.34 mmol/L) B) 9 g/dL (5.59 mmol/L) C) 11 g/dL (6.83 mmol/L) D) 13 g/dL (8.07 mmol/L)

Ans: C

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Feedback: In recent years, health care providers have been educated on the importance of a target hemoglobin of no more than 11 g/dL (6.83 mmol/L) when using erythropoiesis-stimulating agents. As a result, other options are either too low or too high.

Format: Multiple Selection Chapter: 49 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 4 Page and Header: 881, Anemia: Megaloblastic Anemia: Folic Acid Deficiency 34. For what purposes should the nurse administer folic acid to a client? Select all that apply. A) nutritional deficiency B) megaloblastic anemia C) pregnancy or preparation for pregnancy D) sickle cell anemia E) renal failure

Ans: A, B, C

Feedback: Folic acid is indicated for the treatment of megaloblastic anemia caused by sprue and to replace a nutritional deficiency. It is also given to women who are, or plan to become, pregnant to reduce the risk of a neural tube disorder in the fetus. It is not indicated for the treatment of sickle cell anemia or renal failure. Format: Multiple Selection Chapter: 49 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Difficult

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Integrated Process: Nursing Process Objective: 5 Page and Header: 894, Agents for Hemolytic and Aplastic Anemias 35. The nurse is assessing a client suspected to be diagnosed with aplastic anemia. What assessment data would support this diagnosis? Select all that apply. A) bleeding gums B) temperature 100.8°F (38.2°C) C) requires assistance with daily activities D) pallor E) reports a lack of sleep

Ans: A, B, C, D

Feedback: Aplastic anemia is a disease caused by damage to the bone marrow and the bone marrow stem cells. There are deficiencies in all of the blood components formed in the bone marrow; this is called pancytopenia. Low RBC count (anemia), low white blood cell count (leukopenia), and low platelet count (thrombocytopenia) are characteristic of pancytopenia. The client with this situation is at high risk for bleeding (loss of platelets) and infection (loss of white cells) and is often tired and pale (loss of red cells). Insomnia is not generally associated with aplastic anemia but rather the client sleeps more than usual.

Test Generator Questions, Chapter 50, Introduction to the Renal System Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 2, 3

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Page and Header: 901, Introduction 1. The nurse is caring for a client who has been diagnosed with renal failure, and the client’s regulation of vitamin D has been disrupted. When gauging the degree of vitamin D disruption, which assessment data should the nurse assess? A) urine quantity B) urine character C) potassium levels D) calcium levels

Ans: D

Feedback: The renal system has four major functions in the body. One is regulating vitamin D activation, which helps maintain and regulate calcium levels. There is not a direct link between vitamin D levels and urine character, urine quantity, or potassium levels, even though each would be affected by renal failure.

Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 902, The Kidneys: Nephron 2. The client is newly diagnosed with acute renal failure. The client asks the nurse what functional units of the kidneys are involved. What would the nurse reply? A) glomeruli B) renal pelvis C) nephrons D) renal capsules

Ans: C

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Feedback: The functional unit of the kidney is the nephron. There are about 2.4 million nephrons in an adult. These structures filter fluid and make urine. The glomerulus is a tuft of blood vessels with a capillarylike endothelium that allows easy passage of fluid and waste products. The renal pelvis is in a region of the kidney that drains urine into the ureters. The renal capsule is a protective layer, which is made up of the fiber layer, a perirenal or brown fat layer, and the renal parietal layer.

Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 903, Nephron Function: Glomerular Filtration 3. A client has been diagnosed with renal failure and is surprised to learn of the large volume of blood that is filtered by the kidneys. The client asks, “If that much blood gets filtered, why don’t people produce more urine?” In response, the nurse should describe what phenomenon? A) A very large majority of filtrate is returned to circulation. B) Electrolytes draw the water from urine back into circulation. C) Most of the substances that are removed from urine are recycled. D) Most urine is processed internally rather than excreted.

Ans: A

Feedback: Only 1% of filtrate is excreted as urine, since the majority of the filtrate is physiologically useful. Substances are removed from blood, not from urine. Urine is excreted, not processed internally.

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Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 904, The Kidneys: Maintenance of Volume and Composition of Body Fluids: Countercurrent Mechanism 4. The nurse is caring for a client whose renal disease is known to be affecting the countercurrent mechanism in the client’s medullary nephrons. What assessment finding would best corroborate this? A) The client’s urine contains glucose. B) The client is unable to produce concentrated urine. C) The client’s urine output over the past 8 hours is 20 mL. D) The client’s most recent laboratory results indicate hyperkalemia.

Ans: B Feedback: The countercurrent mechanism in the medullary nephrons acts to concentrate or dilute urine. Hyperkalemia and oliguria are consistent with renal failure but are not direct effects of the failure of the countercurrent mechanism. Glucosuria is suggestive of diabetes, not failure of the countercurrent mechanism.

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5. The nurse explains to a client that the nephrons are fragile and require a constant supply of blood and oxygen. What compensatory mechanisms will the nurse explain works to maintain this supply? A) the renin–angiotensin system, causing vasoconstriction B) baroreceptor monitoring of the renal artery C) increased sweating when total water volume becomes too great D) antidiuretic hormone (ADH) release in response to increased blood volume or decreased osmolarity

Ans: A

Feedback: The renin–angiotensin system causes vasoconstriction to improve blood flow to the fragile nephrons. Baroreceptors are not found in the renal artery. Increased sweating is not a reflex reaction to increased total body water. ADH is released in response to decreased blood volume and increased osmolarity.

Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 906, The Kidneys: Regulation of Red Blood Cell Production 6. The nurse is caring for a client who has been diagnosed with renal failure and whose hemoglobin level is 79 mg/L (7.9 mg/dL). What is the nurse’s best action? A) Administer erythropoietin as prescribed. B) Encourage the client to increase fluid intake. C) Monitor the client’s intake and output closely. D) Collaborate with the primary health care provider to arrange dialysis.

Ans: A

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Feedback: When nephrons are lost, as in renal failure, the juxtaglomerular cells that produce erythropoietin are also lost leading to a decrease in red blood cell production and anemia. Dialysis may be necessary, but this will not resolve the client’s anemia. Similarly, pushing fluids will not increase red blood cell production. Fluid balance monitoring is an important aspect of care but will not resolve the client’s anemia.

Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 6 Page and Header: 905, The Kidneys: Maintenance of Volume and Composition of Body Fluids: Calcium Regulation 7. The nurse explains to a client the kidneys regulate calcium levels within a very tight range by the activity of the parathyroid hormone (PTH) and calcitonin. Where does the PTH act to control the calcium level? A) Bowman’s capsule B) the proximal convoluted tubule C) the distal convoluted tubule D) the loop of Henle

Ans: C

Feedback: PTH acts at the distal convoluted tubule to stimulate the reabsorption of calcium to increase serum calcium levels; if it is not present, the calcium is lost. Calcium is filtered at the glomerulus and mostly reabsorbed in the proximal convoluted tubule and the ascending loop of Henle. Bowman’s capsule is part of the renal corpuscle that acts as a sieve or a strainer to allow fluid to flow through but also keeps large particles from entering.

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Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 903, The Kidneys: The Nephron: Tubular Secretion 8. The nurse explains to a client that the kidneys actively remove solutes from the capillary system for excretion in the urine through what process? A) glomerular filtration B) tubular reabsorption C) tubular secretion D) tubular metabolism

Ans: C

Feedback: Tubular secretion is the movement of solutes from the capillary bed into the renal tubule. Glomerular filtration is the passing of fluid from the capillary system into the renal tubule in Bowman’s capsule. Tubular reabsorption is the movement of solutes from the tubule into the capillary system.

Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 3

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Page and Header: 905, The Kidneys: Maintenance of Volume and Composition of Body Fluids: Potassium Regulation 9. The nurse is caring for a client whose potassium level is 5.9 mg/dL (5.9 mmol/L). How will the client’s kidneys respond to this potassium level? A) removing more potassium in the distal convoluted tubule B) inactivating aldosterone C) increasing the excretion of hydrogen ions D) blocking the reabsorption of potassium in Bowman’s capsules

Ans: A

Feedback: The adjustment of potassium levels occurs in the distal convoluted tubule, where aldosterone activates the sodium–potassium exchange, leading to a loss of potassium. Inactivating aldosterone would further increase the client’s potassium level. About 65% of the potassium that is filtered at the glomerulus is reabsorbed at Bowman’s capsule and the proximal convoluted tubule, but this is not the site where potassium levels are adjusted. Hydrogen ions do not directly affect potassium levels.

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D) drowsiness

Ans: B

Feedback: If potassium levels are very high, the retention of sodium in exchange for potassium also leads to retention of water and a dilution of blood volume. Water retention can lead to edema. Hyperkalemia does not necessarily lead to oliguria, even if it has a renal etiology. Pruritus and drowsiness are not associated with hyperkalemia.

Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 903, Nephron Function: Glomerular Filtration 11. The nurse is caring for a client who is suspected of having renal dysfunction. The presence of what substances in the client’s urine would be considered pathological? A) potassium and sodium B) bicarbonate and urea C) blood cells and protein D) creatinine and chloride

Ans: C

Feedback: The various substances normally filtered by the glomerulus, reabsorbed by the tubules, and excreted in the urine include sodium, chloride, bicarbonate, potassium, glucose, urea, creatinine, and uric acid. Within the tubule, some of these substances are selectively reabsorbed into the blood. Glucose scarring or swelling of or damage to the semipermeable membrane leads to the escape of larger plasma components such as

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blood cells or protein into the filtrate. A clinical sign of renal damage is the presence of blood cells or protein in the urine.

Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 906, The Kidneys: Maintenance of Volume and Composition of Body Fluids: Blood Pressure Control 12. The nurse is caring for a client whose blood pressure is 90/49 mm Hg. This client’s kidneys will compensate by secreting what substance? A) antidiuretic hormone B) aldosterone C) renin D) angiotensin

Ans: C

Feedback: Renin converts angiotensinogen to angiotensin I, which is then converted to angiotensin II. The vasoconstriction causes the blood pressure to increase. ADH is secreted by the pituitary gland, not the kidneys.

Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 2 Page and Header: 903, The Kidneys: Structure: Other Structures 13. The nurse is caring for a client who was hit by a baseball, causing injury to the left kidney. The renal response to this injury will primarily involve what? A) the juxtaglomerular apparatus B) the renin–angiotensin–aldosterone system C) the macula densa D) countercurrent mechanism

Ans: C

Feedback: The macula densa consists of immune system cells and chemicals that can respond quickly to any cellular damage or injury. The juxtaglomerular apparatus produces erythropoietin and renin. The renin–angiotensin–aldosterone system works to maintain blood flow to the kidneys. The countercurrent mechanism works to concentrate and dilute the urine.

Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 1, 2 Page and Header: 902, The Kidneys: Nephron 14. A client has sought care because of a gradual onset of oliguria. After diagnostic testing, the client has been diagnosed with early-stage renal failure. The nurse should identify what implication of this client’s diagnosis? A) The client’s renal function has dropped by at least 10%. B) Early intervention will allow the client to begin regenerating nephrons. C) The client should be monitored closely for hypokalemia. D) The client has likely lost around three-quarters of their nephrons.

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Ans: D

Feedback: Only 25% of the total number of nephrons is necessary to maintain healthy renal function, so most clients must have experienced nephron loss of at least 75% to have signs and symptoms of kidney failure. Nephrons cannot regenerate. Renal failure typically causes hyperkalemia, not hypokalemia.

Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 6 Page and Header: 904, The Kidneys: Nephron Function: Tubular Reabsorption 15. The nurse is explaining the kidney’s role in acid–base balance to a client. What function does the nurse state the kidney performs to assist in maintaining acid–base balance within the necessary normal range? A) Excrete acid in the lungs. B) Return bicarbonate to the body’s circulation. C) Return acid to the body’s circulation. D) Excrete bicarbonate in the urine.

Ans: B

Feedback: The kidney performs two major functions to assist in this balance. The first is to reabsorb and return to the body’s circulation any bicarbonate from the urinary filtrate; the second is to excrete acid in the urine.

Format: Multiple Choice Chapter: 50

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Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 906, The Kidneys: Maintenance of Volume and Composition of Body Fluids: Blood Pressure Control 16. The nurse is teaching a client who has been diagnosed with orthostatic hypotension about the role of renin in maintaining blood pressure. What process should the nurse describe? A) “Renin is directly involved in the control of arterial blood pressure and it is essential for proper functioning of the glomerulus.” B) “Renin is involved in venous blood pressure and controls the flow of blood through the tubules.” C) “Renin is directly involved in the control of arterial blood pressure and the flow of blood through the pyramids of the kidney.” D) “Renin is involved in venous blood pressure and it is essential for proper functioning of the glomerulus.”

Ans: A

Feedback: Renin is a hormone directly involved in the control of arterial (not venous) blood pressure. It is essential for proper functioning of the glomerulus, not the “pyramids of the kidney.”

Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1

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Page and Header: 907, The Urinary Tract: Urethra 17. A 78-year-old male client presents at the clinic reporting urinary problems. The client tells the nurse, I have frequency, urgency, and problems initiating and maintaining a urinary stream.” What cause should the nurse suspect? A) enlarged prostate B) decreased bladder function C) increased kidney function D) partially obstructed ureter

Ans: A

Feedback: The ureters, urinary bladder, and urethra make up the rest of the urinary tract. The longer male urethra passes through the prostate gland, which may enlarge or become infected, a problem often associated with advancing age. The client’s advancing age does not increase the risk of decreased bladder function, increased kidney function, or partially obstructed ureter.

Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 907, The Urinary Tract: Urethra 18. A female client presents with a urinary tract infection (UTI). The nurse knows that which factor of a female client’s anatomy and physiology is likely to predispose these clients to UTIs? A) a shorter urethra than male clients B) fewer nephrons than the average male client C) increased blood pressure variation compared to male clients D) longer ureters than male clients

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Ans: A

Feedback: In the female client, the urethra is a very short tube that leads from the bladder to an area populated by normal flora, including Escherichia coli, which can cause frequent bladder infections or cystitis. Females do not have fewer nephrons or longer ureters than males. Blood pressure has no relation with UTIs.

Format: Multiple Selection Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 901, Introduction 19. The nurse is educating a group of clients on the major functions of the renal system. Which functions will the nurse include in the education? Select all that apply. A) regulating stroke volume B) clearing nitrogenous wastes from protein metabolism C) regulating red blood cell production D) regulating blood pressure E) concentrating urine

Ans: B, C, D, E

Feedback: Maintaining the volume and composition of body fluids within normal ranges includes clearing nitrogenous wastes from protein metabolism; maintaining acid–base balance and electrolyte levels; excreting various drugs and drug metabolites; regulating vitamin D activation, which helps to maintain and regulate calcium levels; regulating blood pressure through the renin–angiotensin–aldosterone system; and regulating red

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blood cell production through the production and secretion of erythropoietin. The renal system does not influence the heart’s stroke volume.

Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 902, The Kidneys: Nephron 20. A client asks the nurse, “In what part of the kidney do the nephrons meet?” Which area will the nurse indicate when responding? A) renal pelvises B) loop of Henle C) Bowman’s capsule D) distal convoluted tubule

Ans: A

Feedback: The nephron widens at the distal convoluted tubule and then flows into the collecting ducts, which meet at the renal pelvis. The collecting ducts do not meet in the loop of Henle, Bowman’s capsule, or distal convoluted tubule.

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21. A client asks the nurse, “What regulates the flow of fluid into the glomerulus by increasing or decreasing pressure on either side of the glomerulus?” Which area will the nurse indicate when responding? A) the ascending and descending parts of the loop of Henle B) the arterioles C) the nephron D) the venules

Ans: B

Feedback: The two arterioles around the glomerulus work together to closely regulate the flow of fluid into the glomerulus, increasing or decreasing pressure on either side of the glomerulus as needed. The loop of Henle is part of the nephron. The nephron does not regulate blood flow to the glomerulus, and venules do not contribute.

Format: Multiple Selection Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 3 Page and Header: 904, The Kidney: Maintenance of Volume and Composition of Body Fluids: Sodium Regulation 22. The nurse is explaining kidney function to a client. What will the nurse indicate follows sodium as it is moved out of the filtrate? Select all that apply. A) calcium B) magnesium C) chloride ions D) water E) potassium ions

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Ans: C, D

Feedback: As sodium is actively moved out of the filtrate, it takes chloride ions and water with it. Sodium does not take calcium, magnesium, or potassium ions with it.

Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 904, The Kidney: Maintenance of Volume and Composition of Body Fluids: Sodium Regulation 23. The nurse explains to a client that what acts a catalyst to reabsorb sodium ions into the body? A) aldosterone B) sodium bicarbonate C) angiotensin D) carbonic anhydrase

Ans: D

Feedback: Carbonic anhydrase, an enzyme, speeds the process of carbon dioxide and water combining to form carbonic acid. The carbonic acid immediately dissociates to form sodium bicarbonate, using a sodium ion from the renal tubule and a free hydrogen ion (an acid).

Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 905, The Kidneys: Maintenance of Volume and Composition of Body Fluids: Chloride Regulation 24. A client asks the nurse, “Where is chloride primarily reabsorbed?” Which area will the nurse indicate when responding? A) the loop of Henle B) the nephron C) the kidney D) the distal convolute tubule

Ans: A

Feedback: Chloride is an important negatively charged ion that helps to maintain electrical neutrality with the movement of cations across the cell membrane. Chloride is primarily reabsorbed in the loop of Henle, where it promotes the movement of sodium out of the cell.

Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 905, The Kidneys: Maintenance of Volume and Composition of Body Fluids: Potassium Regulation 25. The nurse knows that electrolytes are maintained in the body by actions within the kidney. Where within the kidney will the nurse explain to a client the level of potassium is adjusted? A) proximal convoluted tubule

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B) distal convoluted tubule C) loop of Henle D) glomerulus

Ans: B

Feedback: The adjusting of potassium levels occurs in the distal convoluted tubule, where aldosterone activates the sodium–potassium exchange, leading to a loss of potassium. This does not occur in the proximal convoluted tubule, loop of Henle, or glomerulus; therefore, the nurse would not indicate these structures.

Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 906, The Kidneys: Regulation of Red Blood Cell Production 26. A client asks the nurse, “What releases erythropoietin when blood flow or oxygenation to the nephron is decreased?” What will the nurse indicate when responding? A) the countercurrent mechanism B) the nephron C) the juxtaglomerular cells D) the glomerulus

Ans: C

Feedback: Whenever blood flow or oxygenation to the nephron is decreased (due to hemorrhage, shock, heart failure, or hypotension), the hormone erythropoietin is also released from the juxtaglomerular cells. The countercurrent mechanism, nephron, or

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glomerulus does not perform this role; therefore, the nurse would not include these in the response.

Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 906, The Kidneys: Regulation of Red Blood Cell Production 27. The nurse is caring for a client who has been diagnosed with renal failure. When reviewing the client’s laboratory values, what would the nurse expect to find? A) increased hematocrit B) increased white blood cell count C) increased platelet count D) decreased hemoglobin

Ans: D

Feedback: Erythropoietin is the only known factor that can regulate the rate of red blood cell production. When a client develops renal failure and the production of erythropoietin drops, the production of red blood cells also falls and the client becomes anemic. Increases in platelets, white blood cells, and hematocrit would not occur.

Format: Multiple Selection Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning

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Objective: 1 Page and Header: 903, The Kidneys: Nephron Function 28. The nurse is teaching a client about the processes involved in nephron function. What should the nurse describe? Select all that apply. A) filtration B) dilution C) secretion D) reabsorption E) concentration

Ans: A, C, D

Feedback: The nephrons function by using three basic processes: filtration, secretion, and reabsorption. Dilution and concentration are functions of sodium regulation.

Format: Multiple Selection Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 3 Page and Header: 904, The Kidneys: Maintenance of Volume and Composition of Body Fluids: Countercurrent Mechanism 29. A nurse is giving a presentation about the function of antidiuretic hormone to a group of clients. The nurse states it is released in response to what stimuli? Select all that apply. A) falling blood volume B) parasympathetic stimulation C) rising sodium levels D) rising calcium levels E) rising parathyroid hormone levels

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Ans: A, C

Feedback: Antidiuretic hormone (ADH) is released in response to falling blood volume, sympathetic stimulation, or rising sodium levels. It is not affected by rising calcium or parathyroid levels.

Format: Multiple Selection Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 904, The Kidneys: Maintenance of Volume and Composition of Body Fluids 30. A client is being treated for dehydration and asks the nurse how the body maintains proper fluid composition and volume. The nurse should describe which regulatory mechanism to the client? Select all that apply. A) concentration of urine B) increased production of erythropoietin C) secretion of electrolytes D) dilution of urine E) increased blood pressure

Ans: A, C, D

Feedback: The kidneys regulate the composition of body fluids by balancing the levels of the key electrolytes, secreting or absorbing these electrolytes to maintain the desired levels. Body fluid volume is controlled by diluting or concentrating urine. Erythropoietin helps to increase red blood cell production, which helps increase oxygen to the organs. Increased blood pressure does not change the volume or composition of body fluids.

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Format: Multiple Selection Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 904, The Kidney: Maintenance of Volume and Composition of Body Fluids: Sodium Regulation 31. The nurse explains the function of natriuretic hormone in relation to urine composition to a client. What will the nurse state causes this hormone to be released? Select all that apply. A) fluid depletion B) fluid overload C) hemodilution D) hemoconcentration E) decreased red blood cell production

Ans: B, C

Feedback: Natriuretic hormone is released in response to fluid overload, not fluid depletion and hemodilution, and not hemoconcentration. Erythropoietin is released in response to decreased red blood cell production.

Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 5 Page and Header: 906, The Kidneys: Maintenance of Volume and Composition of Body Fluids: Blood Pressure Control 32. The nurse is caring for a client following a motorcycle accident. Which finding signifies the renin–angiotensin–aldosterone system is working to maintain blood flow in the kidneys? A) increased temperature B) decreased pulse C) decreased blood pressure D) pain level of 3 on a scale of 1 to 10

Ans: C

Feedback: The renin–angiotensin–aldosterone system is initiated in response to changes in blood volume, so that a decrease in blood pressure would be most likely to initiate this system. An increase in temperature, a decrease in pulse, and a pain level of 3 would not affect blood volume. Format: Multiple Choice Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 7 Page and Header: 907, The Urinary Tract: Key Points 33. A female client is being evaluated for possible cystitis. What assessment data should the nurse focus on to best support this diagnosis? A) the latest urinalysis results B) amount of fluid the client consumes daily C) the color of the most recent voiding D) the client’s current oral temperature

Ans: A

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Feedback: The length of the urethra, which leads from the urinary bladder to the outer body into an area rich in gram-negative bacteria, is pivotal in the diagnosis of a urinary tract infection. Cystitis, or infection of the urinary bladder, is a common problem especially for a female client whose urethra tends to be shorter than that of a male client. A temperature is a general indication of infection but is not exclusive to a urinary tract infection. While the other options are related to urinary function, neither is directly related to infection as is the presence of gram-negative bacteria in the urine.

Format: Multiple Selection Chapter: 50 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 906, The Kidneys: Regulation of Red Blood Cell Production 34. The nurse will assess which client for possible kidney failure? Select all that apply. A) an adult client reporting a recent onset of dizziness when standing up B) a young adult client who experienced a spinal injury while skiing C) a teenage client diagnosed with a ruptured spleen after a car accident D) an older adult client with a reoccurrence of bilateral lower extremity edema E) a pediatric client being treated for anaphylactic shock related to a bee sting

Ans: A, B, C, D, E

Feedback: Acute renal failure occurs whenever blood flow or oxygenation to the nephron is decreased due to hemorrhage (ruptured spleen), shock (neurogenic and anaphylactic), heart failure (reflected by extremity edema), or hypotension (reflected by dizziness).

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Test Generator Questions, Chapter 51, Diuretic Agents Format: Multiple Choice Chapter: 51 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 913, Thiazide and Thiazide-Like Diuretics: Therapeutic Actions and Indications 1. The nurse has administered a diuretic to a client that acts to block the chloride pump in the distal convoluted tubules and leads to a loss of sodium and potassium and a minor loss of water. What type of diuretic did the nurse administer? A) carbonic anhydrase inhibitor B) osmotic diuretic C) potassium-sparing diuretic D) thiazide diuretic

Ans: D

Feedback: Thiazide diuretics work to block the chloride pump, which leads to a loss of sodium, potassium, and some water. They are considered mild diuretics. Carbonic anhydrase inhibitors work to block the formation of carbonic acid and bicarbonate in the renal tubules. Osmotic diuretics use hypertonic pull to remove fluid from the intravascular spaces and to deliver large amounts of water into the renal tubules. Potassium-sparing diuretics are mild and act to spare potassium in exchange for the loss of sodium and water.

Format: Multiple Choice Chapter: 51

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 918, Patient teaching for M.R. 2. The nurse is providing education to a 72-year-old client who has been discharged home on a diuretic. What should the nurse include in the discharge instructions? A) measuring intake and output of urine B) how to properly weigh at home C) to restrict fluids to 500 mL/day D) way to decrease exercise to conserve energy

Ans: B

Feedback: Clients taking a diuretic at home need to learn to weigh themselves every day, at the same time, and in the same clothes to monitor for loss or retention of fluid. They should not be asked to decrease activity. Restricting fluids can lead to a rebound fluid retention when compensatory mechanisms are activated. For most clients, it is unnecessary to monitor intake and output.

Format: Multiple Choice Chapter: 51 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 917, Critical Thinking Scenario: Using Furosemide (Lasix) in Heart Failure: Discussion 3. The nurse is caring for a client who is experiencing pulmonary edema. The client is treated with furosemide. What will the nurse monitor most closely?

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A) sodium levels B) bone narrow function C) calcium levels D) potassium levels

Ans: D

Feedback: Furosemide is associated with loss of potassium, so that the client will need to be monitored carefully for low potassium levels, which could cause cardiac arrhythmias and further aggravate pulmonary edema. The nurse would not monitor sodium or calcium levels or bone marrow function because of the effects of the drug during the acute treatment of pulmonary edema.

Format: Multiple Choice Chapter: 51 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 916, Clinically Important Drug–Drug Interactions 4. The nurse is caring for a client with a history of diabetes and who is being treated with hydrochlorothiazide. What action should the nurse take? A) Ask the primary health care provider for confirmation of the prescription. B) Reinforce diabetic therapy information with the client. C) Give the client an antacid with the medications. D) Check the client’s blood glucose level before giving the medications.

Ans: A Feedback: Decreased effectiveness of antidiabetic agents may occur related to the changes in glucose metabolism; dose adjustment of those agents may be needed. Reinforcement of client knowledge concerning diabetic therapy, while appropriate, is not

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relevant to the existing situation. An antacid would not be relevant in this situation. While blood glucose levels may be affected, notifying the primary health care provider should be the nurse’s initial action.

Format: Multiple Choice Chapter: 51 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 919, Loop Diuretics: Adverse Effects 5. The nurse is assessing a client who takes a loop diuretic. For what adverse effect should the nurse assess? A) hyperkalemia B) alkalosis C) hypertension D) hypercalcemia

Ans: B

Feedback: Alkalosis is a rise in serum pH to an alkaline state and can be caused by loop diuretics. Hypokalemia, hypocalcemia, and hypotension are also adverse effect of these drugs.

Format: Multiple Choice Chapter: 51 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 4 Page and Header: 919, Carbonic Anhydrase Inhibitors: Therapeutic Actions and Indications 6. A client diagnosed with glaucoma has been prescribed a diuretic. What drug does the nurse suspect the client will be prescribed? A) acetazolamide B) spironolactone C) chlorthalidone D) torsemide

Ans: A

Feedback: Acetazolamide is used to treat glaucoma. The inhibition of carbonic anhydrase results in decreased secretion of aqueous humor of the eye. Spironolactone is a potassium-sparing diuretic used to treat edema caused by congestive heart failure, liver disease, hypertension, hyperkalemia, and hyperaldosterone. Chlorthalidone is used to treat edema caused by congestive heart failure, liver disease, kidney disease, and as adjunct treatment of hypertension. Torsemide is not used to treat glaucoma.

Format: Multiple Choice Chapter: 51 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 916, Thiazide and Thiazide-Like Diuretics: Adverse Effects 7. A client presents to the clinic for a 1-month follow-up appointment. The client tells the nurse, “I have been taking chlorothiazide for a month and now I have leg cramps and feel tired all the time.” What will the nurse consider as the most likely cause of the client’s symptoms? A) hypercalcemia

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B) hyponatremia C) hyperchloremia D) hypokalemia

Ans: D

Feedback: Hypokalemia results from the loss of potassium in the distal tubule and causes muscle weakness, fatigue, and arrhythmias. Hyperkalemia presents with cardiac arrhythmias and occasionally muscle weakness. Hypercalcemia is characterized by fatigue, depression, mental confusion, nausea, vomiting, and constipation. Hyponatremia presents with dizziness, fatigue, malaise, thirst, nausea, and mental confusion. Hyperchloremia presents with excessive thirst, dry mucous membranes, elevated blood pressure, muscle weakness, and fatigue.

Format: Multiple Choice Chapter: 51 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 916, Thiazide and Thiazide-Like Diuretics: Clinically Important Drug– Drug Interactions 8. The nurse is caring for a client who is prescribed a thiazidelike diuretic. What drug, if taken with this medication, would cause the nurse to contact the primary health care provider? A) indomethacin B) colestipol C) lithium D) ibuprofen

Ans: C

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Feedback: An increase in the excretion of lithium can occur when taken with a thiazidelike medication, so that special monitoring or a dosage adjustment may be necessary. Indomethacin, colestipol, and ibuprofen do not produce drug-to-drug interactions when given with this classification of medications.

Format: Multiple Choice Chapter: 51 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4, 5 Page and Header: 915, Thiazide and Thiazide-Like Diuretics: Contraindications and Cautions 9. A 68-year-old client, who has type 1 diabetes, is to receive hydrochlorothiazide. Before administration of this medication, what information is most important for the nurse to communicate to the client? A) Insulin doses may need to be increased. B) The type of insulin taken may need to be adjusted. C) The client’s urine will need to be checked for ketones four times a day. D) The client will need to have creatinine clearance measured monthly. Ans: A

Feedback: This medication has the potential to increase glucose levels, requiring an increase in insulin. There would be no reason to change insulin types, to check ketones four times daily, or to have a creatinine clearance once a month.

Format: Multiple Choice Chapter: 51 Client Needs: Physiological Integrity: Physiological Adaptation

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Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Page and Header: 916, Thiazide and Thiazide-Like Diuretics: Adverse Effects 10. The nurse is evaluating an 82-year-old client receiving hydrochlorothiazide. What laboratory value is most likely to result from the medication? A) elevated uric acid levels B) reduced blood urea nitrogen (BUN) levels C) serum potassium level of 4.7 mmol/L (4.7 mEq/L) D) hemoglobin A1c of 4.8% (0.05)

Ans: A

Feedback: Uric acid excretion is decreased because thiazides interfere with its secretory mechanism. High levels of uric acid can result in a condition called gout. Hydrochlorothiazide does not reduce BUN levels. Thiazide diuretics may lead to hypokalemia and increase blood glucose levels. The potassium and hemoglobin A1c levels are normal and not affected by the medication.

Format: Multiple Choice Chapter: 51 Client Needs: Health Promotion and Maintenance Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 914, Focus on Drug Therapy across the Lifespan: Diuretic Agents: Adults, Box 51.1 11. What statement by the client indicates that the client understands the nurse’s teaching about diuretics? A) “I will weigh myself daily and report significant changes.”

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B) “I will have to limit my high sugar foods.” C) “If my leg becomes swollen again, I’ll take an additional pill.” D) “I will take my medication before bedtime on an empty stomach.”

Ans: A

Feedback: Daily weights and blood pressures should be monitored at home in a client taking diuretics. Additional doses cannot be safely taken, and there is no need to limit sugar. Bedtime administration causes nocturia.

Format: Multiple Choice Chapter: 51 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 916, Thiazide and Thiazide-Like Diuretics: Prototype summary: Hydrochlorothiazide 12. A client began taking hydrochlorothiazide 1 week ago and is reporting occasional dizziness when standing up quickly from sitting or lying. What is the nurse’s best action? A) Arrange for the client’s serum potassium levels to be assessed as soon as possible. B) Teach the client about the blood pressure effects of the medication and relevant safety measures. C) Educate the client about the need for bed rest until the body adjusts to the new medication. D) Tell the client to withhold the medication until the client can be assessed by the primary health care provider.

Ans: B

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Feedback: Mild dizziness upon rapid position changes is expected as a result of lowered blood pressure. The nurse should teach the client about this phenomenon and associated falls prevention. This is more likely a result of hypotension than changes in potassium levels. Bed rest would not be necessary and causes many other potential health problems. The nurse should not tell the client to withhold the medication since there is no evidence of severe adverse effects or an emergency.

Format: Multiple Choice Chapter: 51 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 919, Loop Diuretics: Clinically Important Drug–Drug Interactions 13. The nurse would monitor a client for hearing loss if the client takes furosemide with which other medication? A) codeine B) ciprofloxacin C) digoxin D) gentamicin

Ans: D

Feedback: The risk of ototoxicity increases if loop diuretics are combined with aminoglycoside antibiotics, such as gentamicin or cisplatin. No known increased risk of ototoxicity exists when furosemide is taken with codeine, ciprofloxacin, or digoxin.

Format: Multiple Choice Chapter: 51 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 4 Page and Header: 922, Osmotic Diuretics 14. The nurse is caring for a client with a severe head injury. An osmotic diuretic is prescribed. The nurse understands which drug is an osmotic diuretic? A) spironolactone B) bumetanide C) mannitol D) ethacrynic

Ans: C

Feedback: Mannitol is an osmotic diuretic. Spironolactone is a potassium-sparing diuretic. Bumetanide and ethacrynic are loop diuretics. Format: Fill-in-the-Blank Chapter: 51 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 912, Table 51.1 15. A client weighing 130 lb (59.1 kg) with a traumatic head injury has developed increased intracranial pressure. The client is prescribed an initial dose of mannitol at 1.5 g/kg intravenously. The medication is available in premixed 500-mL bags of 20 g/100 mL. How many milliliters of solution should the nurse administer? Round the answer to the nearest whole number.

Ans: 443 mL

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Feedback: The prescribed dose is 1.5 g/kg, and 59.1 × 1.5 = 88.65 g. Cross-multiple this ratio to obtain the correct volume of mannitol: 20 g/100 mL = 88.65 g/X mL. X = 443.25 mL, which rounds to 443 mL.

Format: Multiple Choice Chapter: 51 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 921, Potassium-Sparing Diuretics: Adverse Effects 16. A 91-year-old client is being discharged on the diuretic spironolactone. What assessment finding would the nurse attribute to adverse effects of this medication? A) polyuria and polyphagia B) confusion and irregular heart rate C) diarrhea and positive stool for occult blood (FOB) test D) blood pressure of 160/109 mm Hg

Ans: B

Feedback: The most common adverse effect of potassium-sparing diuretics is hyperkalemia, which can cause lethargy, confusion, ataxia, muscle cramps, and cardiac arrhythmias. Diarrhea, gastrointestinal bleeding, and hypertension are not recognized as adverse effects of spironolactone. Polyuria is expected, but polyphagia is atypical.

Format: Multiple Choice Chapter: 51 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 5 Page and Header: 915, Thiazide and Thiazide-Like Diuretics: Contraindications and Cautions 17. The nurse is conducting an admission assessment for a client who has been prescribed hydrochlorothiazide. What information suggests that the nurse should contact the primary health care provider to discuss safety risks for this client? A) The client is allergic to sulfa drugs. B) The client’s mother is allergic to codeine. C) A blood pressure of 140/96 mm Hg. D) A blood glucose level of 130 mg/dL.

Ans: A

Feedback: Thiazide and thiazidelike diuretics are contraindicated with an allergy to thiazides or sulfonamides to prevent hypersensitivity reactions. None of the other listed assessment findings pose a safety risk. Having a parent allergic to a medication does not indicate that the client shares the same allergy. An allergy to codeine also does not pose a concern for the client prescribed hydrochlorothiazide. The client’s blood pressure and glucose levels should not be adversely affected by the administration of the medication.

Format: Multiple Choice Chapter: 51 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 913, Thiazide and Thiazide-Like Diuretics: Therapeutic Actions and Indications

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18. The nurse is caring for a client who had been newly diagnosed with essential hypertension. The nurse should expect to administer what classification of diuretics as first-line therapy? A) loop diuretics B) carbonic anhydrous inhibitors C) thiazide diuretics D) potassium-sparing diuretics

Ans: C

Feedback: Thiazides are considered to be mild diuretics compared with the more potent loop diuretics. These agents are the first-line drugs used to manage essential hypertension when drug therapy is needed. Loop and potassium-sparing diuretics and carbonic anhydrous inhibitors would be used in combination with or after the thiazide diuretics are no longer effective.

Format: Multiple Choice Chapter: 51 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 916, Thiazide and Thiazide-Like Diuretics: Adverse Effects 19. The nurse is caring for a client with a history of frequent bladder infections. What classification of diuretic would be contraindicated for this client? A) thiazide diuretics B) loop diuretics C) potassium-sparing diuretics D) osmotic diuretics

Ans: A

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Feedback: Urine is slightly alkalinized when the thiazides or thiazidelike diuretics are used because they block reabsorption of bicarbonate. This effect can cause problems for clients who are susceptible to bladder infections. Loop, potassium-sparing, and osmotic diuretics do not have this effect.

Format: Multiple Choice Chapter: 51 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 920, Carbonic Anhydrase Inhibitors: Adverse Effects 20. The nurse is caring for a client who has been diagnosed with open-angle glaucoma. When administering the client’s subsequent medications, the nurse should prioritize what action? A) Limit the client’s fluid intake to 2 L a day. B) Monitor the client’s serum potassium levels. C) Obtain urine for culture and sensitivity 48 hours after starting treatment. D) Educate the client about the need to wear eye patches temporarily.

Ans: B

Feedback: Acetazolamide is the diuretic most commonly used for treating glaucoma. It creates a risk for hypokalemia, which the nurse must monitor. Fluid restriction would be unsafe, and there is no obvious need for culture and sensitivity testing of urine. The signs and symptoms of glaucoma are not affected by wearing eye patches.

Format: Multiple Choice Chapter: 51

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Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 915, Focus on Safe Medication Administration: Explaining Fluid Rebound, Box 51.2 21. A client has just begun to take a prescribed diuretic, and the nurse has taught the client about the phenomenon of fluid rebound. What should the nurse teach the client to do to avoid this complication? A) Temporarily increase potassium intake. B) Increase sodium consumption at this time. C) Void every 2 hours while taking the medication. D) Ensure consistent, adequate fluid intake.

Ans: D

Feedback: Care must be taken when using diuretics to avoid fluid rebound, which is associated with fluid loss. If a client stops taking in water and takes the diuretic, the result will be a concentrated plasma of smaller volume. The client should be encouraged to maintain adequate fluid intake to prevent this adverse effect. Increasing sodium or potassium intake is of no benefit nor is consciously voiding more often.

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22. A client is prescribed furosemide. After reviewing the client’s medication history, what finding would concern the nurse? A) The client takes acetaminophen for headaches. B) The client takes ferrous sulfate for low iron. C) The client takes naproxen for joint pain. D) The client took ampicillin last week for an infection.

Ans: C

Feedback: Naproxen sodium is a nonsteroidal antiinflammatory drug (NSAID). There may also be a decreased loss of sodium and decreased antihypertensive effects if these drugs are combined with indomethacin, ibuprofen, salicylates, or other NSAIDs. The client receiving this combination should be monitored closely, and appropriate dosage adjustments should be made. There is no contraindication to the concurrent use of acetaminophen, ferrous sulfate, or ampicillin.

Format: Multiple Choice Chapter: 51 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 921, Potassium-Sparing Diuretics: Clinically Important Drug–Drug Interactions 23. A client who was recently prescribed spironolactone calls the clinic and reports, “I am not urinating as much as I did when I first started taking this medication.” What would be an appropriate question for the nurse to ask this client? A) “Are you taking a salicylate?” B) “Are you taking acetaminophen?” C) “Are you taking ibuprofen?” D) “Are you adding extra salt to your food?”

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Ans: A

Feedback: The diuretic effect decreases if potassium-sparing diuretics are combined with salicylates. Dosage adjustment may be necessary to achieve therapeutic effects. There is no decrease in effect when spironolactone is combined with acetaminophen, ibuprofen, and increased sodium intake.

Format: Multiple Choice Chapter: 51 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 923, Nursing Considerations for Patients Receiving Diuretics: Nursing Conclusions 24. The nurse is writing a plan of care for a client taking a diuretic. What nursing diagnosis is most likely applicable? A) risk of alterations in fluid volume related to drug effect B) ineffective peripheral tissue perfusion C) imbalanced nutrition: less than body requirements D) fluid volume excess

Ans: A

Feedback: Nursing diagnoses related to drug therapy may include impaired urinary elimination related to drug effect; all diuretics have an influence on urinary output, which may become problematic for the client. There is no significant risk for impairments to peripheral perfusion. Fluid volume deficit is possible but not fluid volume excess. Effects on nutrition are unlikely.

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Format: Multiple Selection Chapter: 51 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 916, Thiazide and Thiazide-Like Diuretics: Prototype Summary: Hydrochlorothiazide 25. The nurse is preparing to give discharge instructions to a client prescribed hydrochlorothiazide. Which adverse effect should the nurse caution the client about? Select all that apply. A) constipation B) dizziness C) polyphagia D) nocturia E) muscle cramps

Ans: B, D, E

Feedback: The adverse effects associated with hydrochlorothiazide are dizziness, vertigo, orthostatic hypotension, nausea, anorexia, vomiting, dry mouth, diarrhea, polyuria, nocturia, muscle cramps, and spasms. The client would not experience polyphagia and constipation.

Format: Multiple Selection Chapter: 51 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2

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Page and Header: 912, Drugs in Focus: Diuretics, Table 51.1 26. A nurse is teaching a group of clients about loop diuretics. What drugs should the nurse include in the teaching? Select all that apply. A) acetazolamide B) torsemide C) ethacrynic acid D) mannitol E) bumetanide

Ans: B, C, E

Feedback: Torsemide, ethacrynic acid, and bumetanide are examples of loop diuretics. Acetazolamide is a carbonic anhydrous inhibitor, and mannitol is an osmotic diuretic.

Format: Multiple Selection Chapter: 51 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 923, Nursing Considerations for Patients Receiving Diuretics: Evaluation 27. The nurse is caring for a client who has been diagnosed with peripheral edema and has just begun taking a diuretic. What assessment should the nurse use to evaluate the effectiveness of this medication? Select all that apply. A) daily weights B) inspection of the lower extremities C) level of consciousness D) urine output E) chest auscultation

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Ans: A, B, D

Feedback: Responsiveness to the use of a diuretic can be measured by daily weights, assessment for edema, and increased urine output. No change in level of consciousness is expected. The client has peripheral edema, not pulmonary edema, so chest auscultation would not be a priority assessment.

Format: Multiple Choice Chapter: 51 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 922, Osmotic Diuretics: Prototype Summary: Mannitol 28. The nurse administers 150 g of mannitol intravenously to a client with increased intracranial pressure (ICP). What assessment related to mediation administration should the nurse prioritize when monitoring the client? A) weight and abdominal girth B) blood pressure C) apical heart rate and rhythm D) respiratory rate and oxygen saturation

Ans: B

Feedback: The most common and potentially dangerous adverse effect related to an osmotic diuretic is the sudden drop in fluid levels, which could result in dangerous hypotension. Weight and abdominal girth may change over time as fluid balance changes, but effects would not be observed as quickly as a drop in blood pressure. The nurse should monitor the client’s respiratory status and heart because of the client’s acute illness, but these are less likely to affect mannitol.

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Format: Multiple Selection Chapter: 51 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 914, Focus on Drug Therapy across the Lifespan-Diuretic Agents: Older Adults, Box 51.1 29. The nurse cares for a client living in a long-term care facility. The client has been prescribed furosemide 40 mg by mouth daily. When beginning this drug therapy, what are appropriate nursing actions? Select all that apply. A) Ensure that the client has easy access to a toilet or commode. B) Remove foods high in potassium from the client’s meal trays. C) Limit the client’s fluid intake to 1 L/day. D) Provide meals low in sodium until the client’s response is known. E) Monitor the client’s blood pressure frequently.

Ans: A, E

Feedback: The client is likely to need to void frequently; the nurse should facilitate this so that incontinent episodes or falls are prevented. As well, the client is at risk for hypotension, so blood pressure monitoring is necessary. Increasing potassium intake is beneficial, not harmful, and there is no direct need for a low-sodium diet. Fluid restriction is potentially dangerous and should not be used as a strategy for managing increased voiding.

Format: Multiple Choice Chapter: 51 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply

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Difficulty: Difficult Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 919, Loop Diuretics: Clinically Important Drug–Drug Interactions 30. A older client has been taking furosemide for several month. Recently, the client began treatment with rivaroxaban. What concern should the nurse discuss with the primary health care provider? A) a decrease in the effectiveness of furosemide B) an increase in the effects of rivaroxaban C) the risk for the development of alkalosis D) the client’s need for a low-salt diet Ans: B Feedback: The risk of ototoxicity increases if loop diuretics are combined with an anticoagulant. Anticoagulation effects of rivaroxaban may increase if taken with a loop diuretic like furosemide. This situation is not likely to affect the effectiveness of the loop diuretic. The risk for the development of alkalosis is not related to the combination of these drugs. A low-salt diet is related to edema management not to the effects of either medication.

Format: Multiple Choice Chapter: 51 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 920, Carbonic Anhydrase Inhibitors: Clinically Important Drug–Drug Interactions 31. A client diagnosed with glaucoma has been treated with a carbonic anhydrase inhibitor (CAI) for several years. The client is now reporting moderately severe finger joint pain related to arthritis. What information should the nurse provide the client when discussing salicylate therapy for the pain?

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A) Salicylate therapy is commonly used in this situation. B) It will be especially important to stay well hydrated. C) The dose of the CAI will need to be decreased. D) Report any nausea or vomiting to your primary health care provider.

Ans: D

Feedback: The enzyme carbonic anhydrase is a catalyst for the formation of sodium bicarbonate. There is higher risk of salicylate toxicity with these medications due to the potential of metabolic acidosis. Therefore, high-dose salicylate therapy is contraindicated, and clients taking low-dose aspirin or other salicylate therapy should be monitored carefully for signs and symptoms of metabolic acidosis such as nausea, vomiting, tachycardia, or confusion. While it is true that aspirin is a commonly used salicylate and that hydration is important, this information is relevant to this situation. The concern will not be managed by decreasing the dosage of the carbonic anhydrase inhibitor to below therapeutic dosage levels.

Format: Multiple Choice Chapter: 51 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 920, Carbonic Anhydrase Inhibitors: Contraindications and Cautions 32. A female client is prescribed a carbonic anhydrase inhibitor to manage glaucoma. The nurse stresses the importance of reporting which change in health status to the primary health care provider immediately? A) pregnancy B) endometriosis C) gestational diabetes D) breast cancer

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Ans: A

Feedback: Some carbonic anhydrase inhibitors have been associated with fetal abnormalities in animals and should not be used during pregnancy in most circumstances. Routine use of a carbonic anhydrase inhibitor during pregnancy is not appropriate; these drugs should be reserved for situations in which the pregnant client has pathological reasons for use, not pregnancy manifestations or complications, and only if the benefit to the client clearly outweighs the risk to the fetus. None of the other options present as contraindications for use of this drug classification.

Test Generator Questions, Chapter 52, Drugs Affecting the Urinary Tract and the Bladder Format: Multiple Choice Chapter: 52 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 926, Introduction 1. The nurse is caring for a client who is 24 hours postoperative. What action can the nurse take to best prevent the development of a urinary tract infection (UTI) in this client? A) Assist the client to ambulate as soon as possible after surgery and encourage continued frequent ambulation. B) Order the client meals that consist of foods and beverages that have a low pH level. C) Ensure that the client’s fluid intake is at least 1.5 L/day and distributed evenly throughout the day. D) Ensure that the client’s urinary catheter is discontinued as soon as possible, as prescribed.

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Ans: D

Feedback: Indwelling catheters are one of the most significant risk factors for UTIs. Consequently, removing them as soon as they are no longer absolutely necessary reduces the likelihood of UTIs. Adequate fluid intake and consumption of acidic beverages are also beneficial but to a lesser degree. Early ambulation has many benefits, but prevention of UTIs is not among the main benefits.

Format: Multiple Choice Chapter: 52 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3 Page and Header: 933, Drugs in Focus: Urinary Tract Antispasmodics, Table 52.3 2. The pediatric nurse is caring for four clients. Which client can the nurse safely and effectively give flavoxate? A) a 1-year-old client B) a 6-year-old client C) a 10-year-old client D) a 14-year-old client

Ans: D

Feedback: Flavoxate prevents smooth muscle spasm in the urinary tract and can be given to pediatric clients older than 12 years of age. Oxybutynin and phenazopyridine may be given to pediatric clients 6 years of age and older. Guidelines for use of an antispasmodic for a pediatric client younger than 6 years have not been established.

Format: Multiple Choice

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Chapter: 52 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 941, Drugs for Treating Benign Prostatic Hyperplasia: Nursing Conclusions 3. A 65-year-old male client who has been diagnosed with benign prostatic hyperplasia is concerned that doxazosin will make him impotent. After the nurse’s discussion with the client, the client remains worried about this adverse effect. What nursing diagnosis will the nurse identify for this client? A) risk for activity intolerance related to decreased sexual performance B) deficient knowledge regarding drug therapy C) nonadherence with drug therapy related to adverse effects D) acute pain related to adverse effects

Ans: C

Feedback: In light of the client’s concerns, the nurse should be aware of the client’s risk for noncompliance because of the possibility of this adverse effect. Deficient knowledge about the drug is a concern, but the client’s fears are plausible, not misinformed. Activity intolerance has not direct relationship with concerns about sexual performance. There is no apparent risk for pain.

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Page and Header: 931, Urinary Tract Antiinfectives: Adverse Effects 4. The nurse is performing client teaching about the urinary antiinfective methenamine. What information is most important for the nurse to share with this client? A) Limit fluid intake. B) Drink orange juice once a day. C) Take the medication with food. D) Take the medication once a day at bedtime.

Ans: C

Feedback: The client should take the medication with food to decrease gastrointestinal adverse effects. The nurse would encourage the client to increase fluid intake to flush the bladder and urinary tract frequently and decrease the opportunity for bacteria growth. Orange juice would be contraindicated because it could cause an alkaline rash and produce alkaline urine, which encourages bacterial growth. This drug is taken two to three times a day and not in a single dose at night.

Format: Multiple Choice Chapter: 52 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 936, Urinary Tract Analgesics: Nursing Considerations for Patients Receiving a Urinary Tract Analgesic 5. A client is taking phenazopyridine and ciprofloxacin for a urinary tract infection. What is the most important instruction for the nurse to provide to the client? A) “You do not need to be alarmed if your urine becomes a reddish-brown color.” B) “Be sure to take your medication with food if you have gastrointestinal irritation.” C) “It is important for you to increase your daily fluid intake by drinking a lot of water.” D) “Tell your primary health care provider if you have yellowing of your eyes or skin.”

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Ans: D

Feedback: Yellowing of the sclera and skin is a sign of drug accumulation in the body and a possible sign of hepatotoxicity. Phenazopyridine should not be used more than 2 days, especially if taken, as here, with an antibacterial agent such as ciprofloxacin. The other suggested options are important and should be included in the instructions given the client. However, the possibility of toxicity is the most important.

Format: Multiple Choice Chapter: 52 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 938, Bladder Protectant: Clinically Important Drug–Drug Interactions 6. A client is taking pentosan polysulfate sodium to decrease pain and discomfort associated with interstitial cystitis. What concurrent medication class does the nurse know could cause an adverse reaction in this client? A) anticoagulants B) antihypertensives C) diuretics D) cardiac glycosides

Ans: A

Feedback: Anticoagulants may react with pentosan polysulfate sodium. This drug has anticoagulant and fibrinolytic effects, which could lead to potential or increased bleeding risks. Antihypertensives, diuretics, and cardiac glycosides do not cause drug–drug interactions with pentosan polysulfate sodium.

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Format: Multiple Choice Chapter: 52 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 942, Drugs for Treating Benign Prostatic Hyperplasia: Contraindications and Cautions 7. The nurse is caring for a client who is pregnant. The client states, “I help my elderly parent with medication administration who is taking dutasteride.” The nurse should instruct the client to take which action? A) Crush the tablets to help facilitate swallowing. B) Avoid touching any crushed or broken tablets. C) Avoid direct contact with the parent while taking the medication. D) Use a barrier contraceptive until the parent’s treatment is complete.

Ans: B

Feedback: Dutasteride contains androgenic hormone blockers that could be absorbed through the skin if the tablets are crushed and broken. These hormone blockers could have negative effects on a fetus. The client should be cautioned not to touch any crushed or broken tablets. The parent will not pose a threat to the client because of this drug therapy. The client does not need barrier contraceptives since the client is pregnant nor would it be relevant in this situation.

Format: Multiple Choice Chapter: 52 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning

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Objective: 2 Page and Header: 943, Nursing Considerations for Patients Receiving Drugs to Treat Benign Prostatic Hypertrophy: Key Points 8. A male client is being treated with medication for benign prostatic hyperplasia (BPH). The nurse should explain to the client that he will experience relief of urinary symptoms because of what drug affect? A) shrinking the gland and/or relaxation the sphincter of the bladder B) increasing testosterone levels, reducing the size of the gland C) locally increasing blood pressure in the prostate, reducing its size D) activating nitric acid, which will dilate blood vessels in the area

Ans: A

Feedback: Drugs frequently used to relieve the signs and symptoms of prostate enlargement include alpha-adrenergic blockers, which relax the sympathetic effects on the bladder and sphincters, and finasteride and dutasteride, which block the body’s production of a powerful androgen. The prostate is dependent on testosterone for its maintenance and development; blocking the androgen leads to shrinkage of the gland and relief of symptoms. These medications do not increase testosterone levels or blood pressure. Dilating blood vessels would further congest the gland and increase symptoms.

Format: Multiple Choice Chapter: 52 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 928, Urinary Tract Antiinfectives: Therapeutic Actions and Indications 9. The nurse is providing care to an 84-year-old client who is receiving nitrofurantoin for a urinary tract infection. The client has recently developed an infection to a venous ulcer

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on the lower leg. Another nurse states, “The nitrofurantoin should likely help with the client’s leg ulcer as well as the UTI.” What is the nurse’s best response? A) “There’s no way of knowing until the client’s wound culture and sensitivity results are received.” B) “Nitrofurantoin isn’t used in high enough doses to affect nongenitourinary infections.” C) “Nitrofurantoin doesn’t have any systemic effects, so the client will need another antibiotic.” D) “That would only be effective if the client were changed from oral to intravenous delivery.”

Ans: C

Feedback: Urinary tract antiinfective do not generally have an antibiotic effect systemically, being activated or effective only in the urinary tract. Changing the dose would be of no benefit. Nitrofurantoin is not available intravenously.

Format: Multiple Choice Chapter: 52 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 932, Urinary Tract Antiinfectives: Nursing Considerations for Patients Receiving Urinary Tract Antiinfectives: Intervention with Rationale 10. A client calls the nurse and reports gastrointestinal upset after taking nitrofurantoin upon wakening each morning. What recommendation should the nurse make to this client? A) Stop taking the medication. B) Take vitamin C along with the medication. C) Take the medicine with or right after meals. D) Continue to take the medicine on an empty stomach.

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Ans: C

Feedback: These adverse effects may result from GI irritation caused by the agent, which may be somewhat alleviated if the drug is taken with food, or from a systemic reaction to the urinary tract irritation. The nurse would not tell the client to stop taking the medication nor would the nurse tell the client to continue taking the medication on an empty stomach. Advising the client to take the medication along with vitamin C would be of no benefit to the client described in the question.

Format: Multiple Choice Chapter: 52 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3, 4, 5 Page and Header: 936, Urinary Tract Analgesics: Contraindications and Cautions 11. A client with a urinary tract infection is experiencing intense burning and pain. The nurse reviews the client’s electronic medical record after the client is prescribed phenazopyridine. What finding would contraindicate the safe and effective use of this medication? A) asthma B) hypertension C) diabetes mellitus D) renal insufficiency

Ans: D

Feedback: Phenazopyridine cannot be given to clients with renal dysfunction. The client’s having asthma, hypertension, or diabetes mellitus would not be a contraindication to the use of this drug.

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Format: Multiple Choice Chapter: 52 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 4, 5 Page and Header: 931, Urinary Tract Antiinfectives: Adverse Effects 12. The nurse is caring for a 79-year-old client who has been diagnosed with a urinary tract infection causing mental status changes. The client is prescribed fosfomycin. What assessment should the nurse prioritize? A) respiratory rate and lung sounds B) assessing for nausea, vomiting, or diarrhea C) monitoring for anticholinergic effects D) heart rate and rhythm

Ans: B

Feedback: Fosfomycin is associated with unpleasant gastrointestinal effects. Respiratory and cardiac function are generally not affected. Fosfomycin does not cause anticholinergic effects.

Format: Multiple Choice Chapter: 52 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 3, 4, 5 Page and Header: 936, Urinary Tract Analgesics: Adverse Effects

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13. A client has been prescribed phenazopyridine for a urinary tract infection (UTI). The nurse would inform the client that phenazopyridine will turn urine what color? A) bluish-green B) reddish-orange C) brown D) black

Ans: B

Feedback: Phenazopyridine turns urine reddish-orange, which may be mistaken for blood. It does not cause the urine to appear bluish-green, brown, or black.

Format: Multiple Choice Chapter: 52 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 927, Focus on Drug Therapy Across the Lifespan: Urinary Tract Agents: Older Adults: Box 52.1 14. The nurse should recommend what action to a group of older adult clients in order to reduce the risk of recurrent urinary tract infections (UTIs)? A) Increase intake of alkaline foods. B) Take tub baths, soaking 15 minutes daily. C) Use sterile gauze pads to cleanse after urinating. D) Drink 2 to 3 L of fluid daily.

Ans: D

Feedback: Many activities are necessary to help decrease bacteria in the urinary tract (e.g., hygiene measures, proper diet, forcing fluids), to facilitate the treatment of UTIs,

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and help the urinary tract antiinfectives be more effective. Forcing fluids increases the amount of urine excreted and prevents urine from sitting in the bladder. It is helpful to keep the urine acidic, not alkaline and avoid sitting in water. The importance of cleansing is to cleanse from front to back. The use of sterile wipes is not necessary.

Format: Multiple Choice Chapter: 52 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 929, Urinary Tract Antiinfectives: Pharmacokinetics 15. The nurse is caring for a client with renal impairment and who is being treated for a urinary tract infection (UTI). Which medication will the nurse anticipate being prescribed for this client? A) salazopyrin B) silver sulfadiazine C) declomycin D) fosfomycin

Ans: D

Feedback: The dosage of fosfomycin, given orally, does not need to be changed in cases of renal impairment. It is the only medication listed that is used in the treatment of urinary tract infections. Declomycin may be used to inhibit antidiuretic hormone in the treatment of chronic inappropriate antidiuretic hormone secretion. Salazopyrin is used in ulcerative colitis. Silver sulfadiazine is used topically to treat Pseudomonas infections.

Format: Multiple Choice Chapter: 52 Client Needs: Physiological Integrity: Reduction of Risk Potential

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Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 929, Patient Teaching for J.K.: Urinary Tract Antiinfective Methenamine: Assessment: History and Examination 16. The nurse is caring for a client who is taking a urinary antiinfective. What assessment should the nurse prioritize to identify the effectiveness of the client’s treatment? A) assessment of 24-hour urine quantity B) monitoring the oral temperature C) urine culture and sensitivity results D) presence of dysuria or flank pain

Ans: C Feedback: The most objective indication of the course of a UTI is the culture and sensitivity testing. The nurse should assess each of the listed parameters, but urine culture testing is priority as the others could be related to multiple factors.

Format: Multiple Choice Chapter: 52 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 929, Patient Teaching for J.K. 17. The nurse is writing a plan of care for an 85-year-old client admitted with a severe urinary tract infection (UTI). What intervention would be an inappropriate for the nurse to include? A) Tell the client to avoid drinking alkaline juice. B) Avoid urinary catheterization.

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C) Increase fluid intake. D) Administer antacids.

Ans: D

Feedback: It would not be appropriate to administer antacids because it will cause the urine to be alkaline and provide more opportunity for bacterial growth. The clients should be encouraged to force fluids and to include nonalkaline juices in those fluids to help acidify the urine. Avoiding urinary catheterization is an important nursing intervention in all clients because catheterization can allow introduction of bacteria in the bladder.

Format: Multiple Choice Chapter: 52 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 3 Page and Header: 939, Drugs for Treating Benign Prostatic Hyperplasia: Therapeutic Actions and Indications 18. The nurse is caring for a client who has been diagnosed with benign prostatic hypertrophy (BPH). The client is prescribed terazosin and asks the nurse, “How does this medication treat the symptoms of BPH?” How will the nurse respond? A) “These medications increase gastric motility.” B) “Terazosin increase skeletal muscle contraction.” C) “This medicine inhibits contraction of the urinary bladder.” D) “Terazosin works by decreasing the blood pressure.”

Ans: C

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Feedback: Alpha1-adrenergic blockers block postsynaptic alpha1-adrenergic receptors, which results in a dilation of arterioles and veins and a relaxation of sympathetic effects on the bladder and urinary tract. This action makes these drugs useful in the treatment of BPH. BPH is characterized by obstructed urine flow as the enlarged prostate gland presses on the urethra. Alpha1-blocking agents can decrease urinary retention and improve urine flow by relaxing muscles in the prostate and urinary bladder.

Format: Multiple Choice Chapter: 52 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 942, Drugs for Treating Benign Prostatic Hyperplasia: Adverse Effects 19. A 72-year-old male client presents at a blood donor drive. The client tells the nurse, “I donate blood on a regular basis.” While reviewing the client’s medication history, the nurse notes the client is currently prescribed dutasteride for benign prostatic hyperplasia (BPH). What explanation would the nurse provide this client as a contraindication to giving blood? A) “The testosterone blocking effects will be passed to those receiving your donated blood.” B) “Blood donation may cause malignant hyperthermia to occur during the donation process.” C) “You could experience severe hypotension while you are in the process of donating blood.” D) “You do not need to donate blood due to the chance of malignant hypertension occurring during the process.”

Ans: A

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Feedback: Clients using either finasteride or dutasteride cannot donate blood for 6 months after the last dose to protect potential blood recipients from exposure to the testosterone blocking effects. The use of the drug dutasteride will not cause this client to develop malignant hyperthermia, malignant hypertension, or severe hypotension during blood donation.

Format: Multiple Choice Chapter: 52 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 928, Drugs in Focus: Urinary Tract Antiinfectives, Table 52.2 20. The nurse is providing care for a client with a urinary tract infection (UTI). Which drug would the nurse expect to administer to this client? A) solifenacin B) pentosan polysulfate sodium C) nitrofurantoin D) alfuzosin

Ans: C

Feedback: Nitrofurantoin is a urinary antiinfective. Solifenacin is an antispasmodic, pentosan polysulfate sodium is a bladder protectant, and alfuzosin is used in the treatment of benign prostatic hyperplasia (BPH).

Format: Multiple Selection Chapter: 52 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 927, Focus on Drug Therapy Across the Lifespan: Urinary Tract Agents: Children, Box 52.1 21. The nurse is caring for a pediatric client who has been diagnosed with a urinary tract infection (UTI). While reviewing the client’s medical record, the nurse notes that the client has been diagnosed with multiple UTIs over the past year. It is important for the nurse to assess the client for which potential cause? Select all that apply. A) urinary tract obstruction B) possible sexual abuse C) excessive apple juice intake D) exposure to bubble baths E) overhydration

Ans: A, B, D

Feedback: A pediatric client with repeated UTIs should be evaluated for potential urinary tract obstruction sexual abuse. Pediatric clients need to be instructed in proper hygiene and should not be given bubble baths if UTIs occur. Repeated UTIs can be related to drinking alkaline juices such as orange or grapefruit but not apple. Pediatric clients should be encouraged to drink a lot of water. Drinking too much water, or overhydration, would not cause repeated infections.

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Page and Header: 927, Focus on Drug Therapy Across the Lifespan: Urinary Tract Agents: Older Adults, Box 52.1 22. A 77-year-old male client has been placed on alfuzosin for benign prostatic hyperplasia (BPH). The nurse explains to the client that because of the medication, it will be necessary to monitor for what? Select all that apply. A) widened pulse pressure B) increased intraocular pressure C) excessive fluid intake D) blood pressure E) incomplete bladder emptying Ans: B, D, E

Feedback: Special precautions to monitor cardiac function, intraocular pressure, blood pressure, and bladder emptying need to be taken when using alpha-adrenergic blockers with these clients. It would not be necessary to monitor pulse pressure or fluid intake in this client.

Format: Multiple Choice Chapter: 52 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 943, Drugs for Treating Benign Prostatic Hyperplasia: Nursing Considerations for Patients Receiving Drugs to Treat Benign Prostatic Hypertrophy: Nursing Conclusions 23. A 72-year-old male client is being treated with doxazosin for benign prostatic hyperplasia (BPH). The nurse will monitor this client for which potential complication? A) sexual dysfunction B) chronic pain C) altered sensory perception

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D) acute confusion

Ans: A

Feedback: Complications related to drug therapy might include sexual dysfunction related to drug effects, acute pain related to headache, central nervous system (CNS) effects, gastrointestinal effects, and risk for injury related to blockage of alpha receptors. Any confusion that the client experiences would be acute, not chronic.

Format: Multiple Selection Chapter: 52 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 934, Urinary Tract Antispasmodics: Contraindications and Cautions 24. The nurse is preparing a plan of care for a 78-year-old client being treated for a recurrent urinary tract infection (UTI). What should the nurse assess for before administering a urinary tract antispasmodic? Select all that apply. A) allergy to eggs B) glaucoma C) pyloric obstruction D) dumping syndrome E) duodenal obstruction

Ans: B, C, E

Feedback: Contraindications include any history of allergy to these drugs to prevent hypersensitivity reactions; pyloric or duodenal obstruction; or other gastrointestinal lesions or obstructions of the lower urinary tract, which could be dangerously exacerbated by these drugs; glaucoma, which could increase intraocular pressure due to

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blockage of the parasympathetic nervous system; and current status of pregnancy or lactation, which would require cautious use. It would not be necessary to assess this client for an allergy to eggs or dumping syndrome.

Format: Multiple Choice Chapter: 52 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 934, Urinary Tract Antispasmodics: Adverse Effects 25. What would be an appropriate nursing intervention for a client on a urinary tract antispasmodic? A) Caution the client against taking hot showers. B) Advise the client to expect a change in color of the sclera. C) Offer sugarless hard candy to relieve a dry mouth. D) Teach the client to perform Kegel exercises.

Ans: C

Feedback: The nurse should offer frequent sips of water or use of sugarless hard candy to alleviate dry mouth because antispasmodics have anticholinergic effects that cause dry mouth. The use of hot water for showers will not cause the client any danger. Urinary antispasmodics do not cause changes in the sclera. Kegel exercises do not relieve bladder spasms.

Format: Multiple Choice Chapter: 52 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Teaching/Learning Objective: 5 Page and Header: 941, Patient Teaching for J.K. 26. The nurse is providing teaching to a client taking methenamine. What statement would be most important for the nurse to include? A) “Drinking cranberry juice will help acidify the urine.” B) “Take sodium bicarbonate with the medication to make the urine alkaline.” C) “Limit your fluid intake to 26 ounces per day.” D) “While you are taking this drug, limit your intake of foods high in sodium.”

Ans: A

Feedback: Urinary tract antiinfectives act specifically within the urinary tract to destroy bacteria, either through a direct antibiotic effect or through acidification of the urine. Therefore, the nurse would not instruct the client to take sodium bicarbonate, limit fluid intake, or limit their intake of foods high in sodium.

Format: Multiple Selection Chapter: 52 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 939, Drugs for Treating Benign Prostatic Hyperplasia 27. The nurse is caring for a client who is beginning treatment for benign prostatic hyperplasia (BPH). The nurse knows this client may be treated with which classification of drugs? Select all that apply. A) urinary antiinfectives B) urinary antispasmodics C) alpha-adrenergic blockers D) testosterone production blockers

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E) urinary analgesics

Ans: C, D

Feedback: Alpha-adrenergic blockers and testosterone production blockers are drugs used in the treatment of benign prostatic hyperplasia. Urinary antiinfectives are used to treat urinary tract infections. Urinary antispasmodics are used to treat bladder spasms, and urinary analgesics are used in the treatment of pain associated with urinary tract infections.

Format: Multiple Choice Chapter: 52 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 939, Drugs for Treating Benign Prostatic Hyperplasia: Therapeutic Actions and Indications 28. The nurse is admitting a 79-year-old male client whose current medication regimen includes oral tamsulosin 0.5 mg/d. The nurse should perform which intervention for this client? A) Monitor for signs of a urinary tract infection. B) Send a urine specimen for a culture and sensitivity. C) Assess the client for urinary urgency or frequency. D) Check for the presence of a systemic infection.

Ans: C

Feedback: Tamsulosin is an alpha-blocker used to treat BPH. Consequently, the nurse should assess for any urgency or frequency that accompany the condition. It is not used to treat infections, so there is not normally a need for culture and sensitivity testing.

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Format: Multiple Selection Chapter: 52 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 4, 5 Page and Header: 938, Bladder Protectant: Nursing Considerations for Patients Receiving a Bladder Protectant: Assessment: History and Examination 29. A client with interstitial cystitis has just begun to take pentosan polysulfate sodium. The nurse would notify the primary health care provider if the client exhibited which symptom? Select all that apply. A) petechiae B) anorexia C) decreased blood pressure D) blood in the urine E) headache

Ans: A, C, D

Feedback: Adverse effects associated with pentosan use include bleeding that may progress to hemorrhage (related to the drug’s heparin effects), headache, alopecia, and gastrointestinal disturbances. It would be necessary to notify the primary health care provider if the client showed any signs of bleeding. Anorexia and headaches are not associated with this drug.

Format: Multiple Choice Chapter: 52 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning

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Objective: 3, 4, 5 Page and Header: 938, Bladder Protectant: Nursing Considerations for Patients Receiving a Bladder Protectant: Intervention with Rationale 30. The nurse is providing discharge instructions to a client taking pentosan polysulfate sodium. Which statement by the client indicates a need for further instruction? A) “I will make sure and take this medication with my breakfast.” B) “I will call the doctor if I start to have any unusual bruises.” C) “This drug I am taking may cause me to lose hair.” D) “I will take acetaminophen if I develop a headache.”

Ans: A

Feedback: Pentosan polysulfate sodium should be taken on an empty stomach, either 1 hour before or 2 hours after meals. The client should call the primary health care provider at the first sign of bleeding. Alopecia and headache may occur with this medication.

Format: Multiple Choice Chapter: 52 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 939, Focus on Herbal and Alternative Therapies, Box 52.3 31. A client diagnosed with benign prostatic hyperplasia (BPH) has been self-treating with an herbal supplement called saw palmetto. The nurse would know which drug used to treat BPH is contraindicated in this client? A) tamsulosin B) finasteride C) alfuzosin D) terazosin

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Ans: B

Feedback: Saw palmetto is an herbal therapy that has been used very successfully for the relief of symptoms associated with BPH. Clients with BPH should be cautioned not to combine saw palmetto with finasteride because serious toxicity can occur. There is no contraindication in the use of tamsulosin, alfuzosin, and terazosin, which are alphaadrenergic blockers. Finasteride is a testosterone blocking agent.

Format: Multiple Selection Chapter: 52 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 942, Drugs for Treating Benign Prostatic Hyperplasia: Clinically Important Drug–Drug Interactions 32. A male client is being prescribed tamsulosin. What information found in the client’s medical record would the nurse report to the primary health care provider before the medication therapy is initiated? Select all that apply. A) current prescription for lisinopril B) a history of angina C) an allergy to tree nuts D) history of erectile dysfunction E) recent hospitalization for congestive heart failure (CHF)

Ans: A, B, D, E Feedback: There is a possibility of increased antihypertensive effects if the alphaadrenergic blockers are combined with any other antihypertensives like lisinopril, nitrates for angina or CHF, or erectile dysfunction drugs, all of which can cause lower blood pressure. This medical history needs further evaluation in order to assure the client’s safety. There are no known contraindications related to nut allergies.

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Format: Multiple Choice Chapter: 52 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 939, Focus on Herbal and Alternative Therapies, Box 52.3 33. A client is prescribed dutasteride for a long history of benign prostatic hyperplasia (BPH). The client tells the nurse, “I am taking saw palmetto it is working well.” What action should the nurse suggest to the client regarding the herbal therapy? A) The herbal therapy should be stopped immediately. B) The herbal therapy should be discussed with the primary health care provider. C) Be cautious about changing product the brand of herbal being used. D) Restrict taking the herbal to 3 days a week.

Ans: C

Feedback: Clients should be cautioned that random studies of various saw palmetto products have shown great variation in contents and activity of the tablets. The option to discuss the herbal therapy is not inappropriate but current research supports the continued use of the same brand product. This logic also makes stopping the herbal therapy unnecessary but not inappropriate. There is no research to support taking the herb only 3 days a week. If clients choose to use this alternative therapy, the clients should be cautioned to check products carefully and to avoid switching products once they have success with one.

Test Generator Questions, Chapter 53, Introduction to the Respiratory System

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Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 949, Key Terms, Cilia 1. A client asks the nurse what microscopic, hairlike projections of the nasal cell membranes transport foreign substances toward the throat. What structures will the nurse state perform this role? A) goblet cells B) cilia C) alveolar sacs D) sinuses

Ans: B

Feedback: Cilia are found in the epithelial cells of the lining of the nasal cavity and are constantly in motion directing mucus and trapped substances down toward the throat. Goblet cells are found in the epithelial lining and produce mucus, which traps foreign substances. Alveolar sacs are located in the lower respiratory tract and are considered the functional units of the lung. Sinuses are air-filled passages through the skull, which open into the nasal cavity.

Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1

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Page and Header: 950, Structure and Function of the Respiratory System: The Conducting Airways 2. A client has been up all night with intense coughing spasms and asks the nurse, “How is all this coughing related to my bronchitis?” The nurse tells the client that a cough is initiated by irritation to receptors in what location? A) nasal cavity B) bronchi C) pharynx D) sinus cavities

Ans: B

Feedback: Irritation to bronchial receptors will initiate a cough, which causes air to be pushed through the bronchial tree. Irritation to receptors in the nasal cavity, pharynx, and sinuses are more likely to initiate the sneeze reflex.

Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 955, Respiratory Pathophysiology: Ventilation and Gas Exchange Disorders: Respiratory Distress Syndrome and Acute Respiratory Distress Syndrome 3. What client should the nurse monitor most closely for signs and symptoms of respiratory distress syndrome? A) a client with a 15 pack-year history of smoking B) a client with seasonal allergies C) a client with acquired immunodeficiency syndrome (AIDS) D) a neonatal client born premature

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Ans: D

Feedback: Respiratory distress syndrome (RDS) causes obstruction at the alveolar level. It is frequently seen in premature clients who are born before the lungs have fully developed and while surfactant levels are still very low. For this reason, this neonatal client would be at higher risk than a smoker, a client with AIDS, or a client with allergies.

Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 952, Structure and Function of the Respiratory System: Ventilation 4. The nurse is caring for a client who suffered a head injury and is now having difficulty breathing. The client should be assessed for damage to what part of the central nervous system? A) cerebral cortex B) cerebellum C) hypothalamus D) medulla oblongata Ans: D

Feedback: The act of breathing is controlled by the medulla, which depends on a functioning muscular system and a balance between the sympathetic and parasympathetic systems. The cerebral cortex, cerebellum, and hypothalamus are not directly involved with this process.

Format: Multiple Choice

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Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 953, Respiratory Pathophysiology: Seasonal Rhinitis 5. The nurse is caring for a client who has seasonal rhinitis and wants to know what causes this to occur. What is the nurse’s best response? A) “You are experiencing symptoms because bacteria have entered the nose and caused a local infection.” B) “Your upper airways are inflamed because you inhaled an antigen, causing sneezing and watery eyes.” C) “Your sympathetic nervous system is responding to stress in your life causing you to have nasal congestion.” D) “Your symptoms are happening because pathogens are invading the tissues in your nose and causing necrosis of the superficial cells.”

Ans: B

Feedback: Seasonal rhinitis usually occurs when the upper airways become inflamed because of the body’s response to an inhaled antigen. The sympathetic system’s response to stress usually opens the airways and does not cause inflammation. Bacteria entering the nose do not cause inflammation of the rest of the upper airways or necrosis.

Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 3

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Page and Header: 955, Respiratory Pathophysiology: Ventilation and Gas Exchange Disorders: Respiratory Distress Syndrome and Acute Respiratory Distress Syndrome Respiratory 6. A nurse is caring for a client who has been diagnosed with acute respiratory distress syndrome (ARDS). What is a characteristic of this condition? A) accumulation of copious amounts of very thick secretions in the lungs B) loss of elastic tissue of the lungs and destruction of alveolar walls C) progressive loss of lung compliance and increasing hypoxia D) reversible bronchospasm, inflammation, and hyperactive airways

Ans: C

Feedback: ARDS is characterized by progressive loss of lung compliance and increasing hypoxia and occurs as a result of a severe insult to the body. Accumulation of copious amounts of thick secretions in the lungs is associated with cystic fibrosis. Chronic obstructive pulmonary disease (COPD) is characterized by loss of the elastic tissue of the lung, destruction of alveolar walls, and hyperinflation with tendency to collapse with expiration. Reversible bronchospasm, inflammation, and hyperactive airways are characteristics of asthma.

Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 953, Respiratory Pathophysiology: Pneumonia 7. A nurse is caring for an 80-year-old client who has been diagnosed with pneumonia. What would be the most appropriate for the nurse to assess this client for? A) decreased cardiac output B) impaired gas exchange

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C) inability to maintain personal health D) aspiration

Ans: B

Feedback: Pneumonia causes swelling, engorgement, and exudation of protective sera in the lower respiratory tract. The respiratory membrane is affected, resulting in decreased gas exchange. Pneumonia does not directly affect cardiac output. There is also no indication that this client has pneumonia because of ineffective health maintenance. Aspiration is a common cause of pneumonia but is not normally a consequence.

Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 953, Respiratory Pathophysiology: Seasonal Rhinitis 8. The nurse is providing education to a client experiencing upper airway responses to mold and dust. What is the client’s most likely diagnosis? A) cystic fibrosis B) adult respiratory distress syndrome (ARDS) C) atelectasis D) seasonal rhinitis

Ans: D

Feedback: Seasonal rhinitis is an inflammation of the nasal cavity; it occurs when the upper airways respond to a specific antigen such as pollen, mold, or dust. Cystic fibrosis, atelectasis, and ARDS are not associated with an allergic response.

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Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 953, Respiratory Pathophysiology: Seasonal Rhinitis 9. A client reports an inability to breathe nasally because of severe rhinitis. The nurse should identify what important role in breathing that is disrupted when the nasal passages are blocked? A) phagocytosis of pathogens B) presence of nasal congestion C) exhalation of carbon dioxide D) respiratory regulation of acid–base balance

Ans: B

Feedback: Air usually moves into the body through the nose and into the nasal cavity. Rhinitis results in the inflammatory response causing nasal congestion. Phagocytosis happens in goblet cells in the nose, but these are not wholly limited to that location. Carbon dioxide is exhaled through the mouth, not just the nose. Similarly, acid–base balance is not threaded by blocked nasal passages.

Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning

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Objective: 3 Page and Header: 952, Respiratory Pathophysiology: The Common Cold 10. A client asks the nurse what causes a cold. The nurse would tell the client that the common cold is most often caused by which finding? A) gram-positive bacteria B) congenital anomalies C) viruses D) fungi

Ans: C

Feedback: Various viruses cause the common cold. These viruses invade the tissues of the upper respiratory tract, initiating the release of histamine and prostaglandins and causing an inflammatory response. Bacteria and fungi can cause a respiratory infection, but the disorder commonly known as a cold is caused by a virus. Congenital anomalies can lead to an increased risk for infection but are not the cause. Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 952, Structure and Function of the Respiratory System: Ventilation 11. The nurse is caring for a client whose respiratory rate has increased from 21 to 32 breaths/min. What ultimately causes this change in status? A) stimulation by the medulla B) release of a respiratory-stimulating hormone (RSH) C) increased peripheral oxygen levels D) increased blood pH

Ans: A

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Feedback: Respiration, or the act of breathing to allow gas exchange, is controlled by the central nervous system. The inspiratory muscles—diaphragm, external intercostal muscles, and abdominal muscles—are stimulated to contract by the respiratory center in the medulla. “RSH” does not exist. Increased oxygen and pH levels would tend to slow, rather than increase, respiratory rates.

Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 2 Page and Header: 949, Key Terms, Alveoli 12. When describing the location where gas exchange takes place to a client, what part of the anatomy should the nurse explain the function of? A) trachea B) bronchioles C) alveoli D) bronchi

Ans: C

Feedback: Gas exchange occurs across the respiratory membrane in the alveolar sac. It does not occur in the bronchioles, the trachea, or the bronchi.

Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate

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Integrated Process: Teaching/Learning Objective: 1 Page and Header: 951, Structure and Function of the Respiratory System: Gas Exchange 13. The nurse is teaching clients about the need for lubrication of the alveoli for effective gas exchange and that it is produced by type II cells of the alveoli. The nurse would indicate that what substance is produced by type II cells of the alveoli? A) erythrocytes B) lymphatic fluid C) surfactant D) pleural fluid

Ans: C Feedback: Type II cells produce surfactant. Erythrocytes are made in the bone marrow. Lymphatic fluid is produced by lymph glands; pleural fluid is secreted by cells in the pleural cavity.

Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 955, Summary 14. When describing gas exchange, the nurse should teach a client that oxygen and carbon dioxide enter and leave the body by what method? A) osmosis B) diffusion C) passive transport D) active transport

Ans: B

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Feedback: The alveolar sac holds the gas, allowing needed oxygen to diffuse across the respiratory membrane into the capillary, whereas carbon dioxide, which is more abundant in the capillary blood, diffuses across the membrane, and enters the alveolar sac to be expired.

Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Page and Header: 951, Structure and Function of the Respiratory System: The Respiratory Airways 15. A client has been diagnosed with stenosis of the pulmonary artery that inhibits the flow of unoxygenated blood between the right ventricle and the alveoli. The nurse expects what function to be impaired in this client? A) perfusion B) ventilation C) expiration D) diffusion

Ans: A

Feedback: The lung tissue receives its blood supply from the bronchial artery, which branches directly off the aorta. The alveoli receive unoxygenated blood from the right ventricle via the pulmonary artery. The delivery of this blood to the alveoli is referred to as pulmonary perfusion, not diffusion. Expiration is the act of exhaling to rid the body of excess carbon dioxide. Ventilation is the movement of air in and out of the lungs.

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Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 3 Page and Header: 955, Respiratory Pathophysiology: Ventilation and Gas Exchange Disorders: Respiratory Distress Syndrome and Acute Respiratory Distress Syndrome Respiratory 16. The nurse is caring for a client who has been diagnosed with acute respiratory distress syndrome (ARDS). What is the nurse’s best intervention? A) administration of oral corticosteroids B) cardiopulmonary resuscitation C) establishing mechanical ventilation D) deep breathing and coughing exercises

Ans: C

Feedback: Acute respiratory distress syndrome (ARDS) is characterized by progressive loss of lung compliance and increasing hypoxia. Mechanical ventilation is necessary, but resuscitation would only be necessary in cases of arrest. The client would be incapable of performing breathing exercises or taking oral medications.

Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4

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Page and Header: 954, Respiratory Pathophysiology: Ventilation and Gas Exchange Disorders: Chronic Obstructive Pulmonary Disease 17. While assessing a new client, the nurse notes the following: productive cough, respiratory rate of 22 breaths/min, oxygen saturation of 90% on room air, afebrile, and increased secretions. The client has a 20-year history of smoking 1.5 packs of cigarettes daily. What diagnosis does the nurse anticipate? A) pneumonia B) cystic fibrosis C) pleural effusion D) chronic obstructive pulmonary disease (COPD)

Ans: D

Feedback: Chronic obstructive pulmonary disease (COPD) is a permanent, chronic obstruction of airways, often related to cigarette smoking. It is caused by two related disorders, emphysema and chronic bronchitis, both of which result in airflow obstruction on expiration, as well as overinflation of the lungs and poor gas exchange. Emphysema is characterized by loss of the elastic tissue of the lungs, destruction of alveolar walls, and a resultant alveolar hyperinflation with a tendency to collapse with expiration. Chronic bronchitis is a permanent inflammation of the airways with mucous secretion, edema, and poor inflammatory defenses. Characteristics of both disorders often are present in the person with COPD. Pneumonia would likely cause a fever. Because of the client’s smoking history, COPD is more likely than pleural effusion. Cystic fibrosis is a genetic disease of excessive pulmonary tract secretions and gastrointestinal tract involvement.

Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 4 Page and Header: 950, Structure and Function of the Respiratory System; 954, Respiratory Pathophysiology: Ventilation and Gas Exchange Disorders: Asthma 18. A client is admitted for an asthma attack caused by an allergic reaction to a medication. The nurse knows the immediate release of which substance most likely caused this severe allergic response? A) antihistamine B) histamine C) epinephrine D) surfactant

Ans: B

Feedback: Asthma is characterized by reversible bronchospasm, inflammation, and hyperactive airways. The hyperactivity is triggered by allergens or nonallergic inhaled irritants or by factors such as exercise and emotions. The trigger causes an immediate release of histamine by mast cells, which results in bronchospasm in about 10 minutes. An antihistamine is used to treat allergic responses because it counteracts the effects of histamine. Surfactant is a lubricating substance that is necessary to keep the alveoli open. Epinephrine is a medication used to treat acute allergic responses.

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19. A nurse is discussing cystic fibrosis (CF) with a couple who have just given birth to an infant with this disorder. Which respiratory component of this disease should the nurse explain? A) bronchospasm B) infection C) excessive respiratory tract secretions D) chemical irritation of the respiratory tract

Ans: C

Feedback: CF is a hereditary disease involving the exocrine glands of the respiratory, gastrointestinal, and reproductive tracts. CF results in the accumulation of copious amounts of very thick secretions in the lungs. CF is not caused by bronchospasm or chemical irritation. Clients with cystic fibrosis develop many lung infections but that is secondary to the disease, not the underlying disease process itself.

Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Page and Header: 953, Respiratory Pathophysiology: Respiratory Tract Infections: Ventilation and Gas Exchange Disorders: Bronchiectasis 20. A client presents to the clinic with a temperature of 101.5°F (38.6°C) malaise, myalgia, arthralgia, and a purulent, productive cough. The client states “The fever just started today but I have had this cough for many, many months.” Which diagnoses would the nurse suspect? A) acute pneumonia B) bronchitis C) chronic obstructive pulmonary disease (COPD)

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D) bronchiectasis Ans: D

Feedback: Bronchiectasis is a chronic disease that involves the bronchi and bronchioles. It is characterized by dilation of the bronchial tree and chronic infection and inflammation of the bronchial passages. With chronic inflammation, the bronchial epithelial cells are replaced by a fibrous scar tissue. The loss of the protective mucus and ciliary movement of the epithelial cell membranes, combined with the dilation of the bronchial tree, leads to chronic infections in the now unprotected lower areas of lung tissue. Clients with bronchiectasis often have an underlying medical condition that makes them more susceptible to infections (e.g., immune suppression, acquired immune deficiency syndrome, chronic inflammatory conditions). Clients present with the signs and symptoms of acute infection, including fever, malaise, myalgia, arthralgia, and a purulent, productive cough. Clients who have pneumonia and bronchitis may present with the above symptoms, but it is not a chronic disorder. COPD is a chronic disorder, but the client with this disorder has more symptoms related to shortness of breath.

Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 953, Respiratory Pathophysiology: Respiratory Tract Infections: Ventilation and Gas Exchange Disorders: Atelectasis 21. The nurse is assessing a client following surgery. The nurse suspects the client may have developed atelectasis. What assessment finding by the nurse best supports this suspicion? A) oral temperature of 99.3°F (37.4°C) B) crackles on lung auscultation C) chest pain on exertion

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D) hemoptysis

Ans: B

Feedback: Clients with atelectasis may present with crackles, dyspnea, fever, cough, hypoxia, and changes in chest wall movement. This client’s temperature is within normal ranges. Hemoptysis and chest pain are not normally associated with atelectasis.

Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 4 Page and Header: 953, Respiratory Pathophysiology: Respiratory Tract Infections: Ventilation and Gas Exchange Disorders: Atelectasis 22. A client returns to the unit after thoracic surgery with a water-sealed chest drainage system. What should the nurse instruct the client and family this drainage system is used for? A) maintaining positive chest wall pressure B) monitoring pleural fluid C) providing positive intrathoracic pressure D) re-expanding the lung and restoring the negative pressure to the space between the pleura

Ans: D

Feedback: In the case of a pneumothorax, treatment would involve insertion of a chest tube to restore the negative pressure to the space between the pleura. A water-sealed chest drainage system does not maintain positive chest wall pressure, monitor pleural fluid, or provide positive intrathoracic pressure.

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Format: Multiple Choice Chapter: 53 Client Needs: Health Promotion and Maintenance Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 4 Page and Header: 954, Respiratory Pathophysiology: Ventilation and Gas Exchange Disorders: Chronic Obstructive Pulmonary Disease 23. The nurse is teaching a group of adult clients about health promotion. What should the nurse recommend in order to minimize the clients’ risk of COPD? A) Get screened for the genetic markers for COPD. B) Receive the annual influenza vaccination. C) Minimize exposure to dust and mold. D) Avoid smoking.

Ans: D

Feedback: COPD is a permanent, chronic obstruction of airways, often related to cigarette smoking. Vaccines do not confer protection and dust and mold are not normally implicated. Genetic factors are minimal; smoking is the most salient risk factor.

Format: Multiple Choice Chapter: 53 Client Needs: Health Promotion and Maintenance Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4

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Page and Header: 954, Respiratory Pathophysiology: Ventilation and Gas Exchange Disorders: Cystic Fibrosis 24. The nurse is caring for a pediatric client who has been diagnosed with cystic fibrosis (CF). The client’s parents ask, “Why is treatment used since CF is a terminal illness?” What would be the nurse’s best response? A) “Treatment is aimed at preventing and treating infections.” B) “Treatment is aimed at lowering high levels of carbon dioxide in the blood.” C) “Treatment is aimed at raising oxygen levels to the extremities.” D) “Treatment is aimed at survival until lung transplantation can occur.”

Ans: A

Feedback: Treatment is aimed at keeping the secretions fluid and moving, maintaining airway patency, and preventing and treating infections as much as possible. Treatment for CF is not aimed at lowering hypercapnia or raising oxygen levels to the extremities. Treatment for CF is not aimed at maintaining the child until lung transplantation can occur.

Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 954, Respiratory Pathophysiology: Ventilation and Gas Exchange Disorders: Cystic Fibrosis 25. The nurse is caring for a 6-year-old client who has been diagnosed with cystic fibrosis. The client’s parents ask how the cystic fibrosis started. What should the nurse explain as a key feature in the presentation of this disease? A) airway obstruction B) blood-tinged sputum

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C) bronchospasm D) clubbing of the extremities

Ans: A

Feedback: CF results in the accumulation of copious amounts of very thick secretions in the lungs. Eventually, the secretions obstruct the airways, leading to destruction of the lung tissue. Clubbing of the extremities occurs after many years of inadequate oxygenation. Hemoptysis and bronchospasm are atypical.

Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 953, Respiratory Pathophysiology: Respiratory Tract Infections: Ventilation and Gas Exchange Disorders: Bronchiectasis 26. The nurse is caring for a client who is experiencing an attack of acute bronchiectasis. What is the principal pathologic finding in the diagnosis of bronchiectasis? A) increase in the red blood cell concentration in the blood B) leakage of fluid into the alveolar interstitial spaces C) chronic, irreversible dilation of the bronchi and bronchioles D) obstruction of the pulmonary vasculature by a clot

Ans: C

Feedback: Bronchiectasis is a chronic disease that involves the bronchi and bronchioles. It is characterized by dilation of the bronchial tree, chronic infection, and inflammation of the bronchial passages. It is not caused by increased red blood cell concentration in the

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blood, leakage of fluid into the alveolar interstitial spaces, or the obstruction of the pulmonary vasculature by a clot.

Format: Multiple Choice Chapter: 53 Client Needs: Health Promotion and Maintenance Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 954, Respiratory Pathophysiology: Respiratory Tract Infections: Ventilation and Gas Exchange Disorders: Asthma 27. The nurse is developing the teaching for a client with asthma. What would be an important component for the nurse to emphasize? A) Smoking up to a half a pack of cigarettes weekly is allowable. B) Chronic inhalation of nonallergic inhaled irritants can trigger an attack. C) Minor respiratory infections should not be treated. D) Activities of daily living (ADLs) should be completed in the morning hours.

Ans: B

Feedback: Asthma is characterized by reversible bronchospasm, inflammation, and hyperactive airways. The hyperactivity is triggered by allergens or nonallergic inhaled irritants or by factors such as exercise and emotions. The trigger causes an immediate release of histamine, which results in bronchospasm in about 10 minutes. The later response (i.e., 3 to 5 hours) is cytokine-mediated inflammation, mucous production, and edema contributing to obstruction. Clients with asthma should not smoke at all and even minor respiratory infections should be treated to prevent an exacerbation of asthma, and ADLs should be completed whenever the client feels able.

Format: Multiple Choice

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Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 953, Respiratory Pathophysiology: Respiratory Tract Infections: Ventilation and Gas Exchange Disorders: Bronchiectasis 28. A nurse is caring for a client who has been diagnosed with chronic bronchiectasis. The nurse should assess the client for what clinical manifestations? A) purulent cough B) angina C) pigeon chest D) pulmonary hypertension

Ans: A

Feedback: Clients present with the signs and symptoms of acute infection, including fever, malaise, myalgia, arthralgia, and a purulent, productive cough. A client with bronchiectasis would not present with pulmonary hypertension, chest deformity, or chest pain related to lack of oxygen to the heart.

Format: Multiple Choice Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 4 Page and Header: 954, Respiratory Pathophysiology: Ventilation and Gas Exchange Disorders: Cystic Fibrosis 29. The nurse is caring for a pediatric client who has been diagnosed with cystic fibrosis (CF). What should the nurse identify as the hallmark pathology of CF?

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A) lung bleeding, infection, and eventual bronchiectasis B) airway obstruction, inflammation, and tissue damage C) atelectasis, infection, and chronic obstructive pulmonary disease D) bronchial mucous plugging, infection, and chronic obstructive pulmonary disease

Ans: B

Feedback: CF results in the accumulation of copious amounts of very thick secretions in the lungs. Eventually, the secretions obstruct the airways, leading to destruction of the lung tissue. Chronic obstructive pulmonary disease (COPD) is not an eventual outcome in this disease. Bleeding is atypical.

Format: Multiple Selection Chapter: 53 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 953, Respiratory Pathophysiology: Respiratory Tract Infections: Ventilation and Gas Exchange Disorders: Bronchiectasis 30. The nurse is aware that clients diagnosed with bronchiectasis often have an underlying medical condition that increases the chance for infection. What are some of these medical conditions? Select all that apply. A) rheumatoid arthritis B) AIDS C) diabetes mellitus D) hydrocephalus E) recent organ transplant

Ans: A, B, E

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Feedback: Clients with bronchiectasis often have an underlying medical condition that makes them more susceptible to infections. These underlying medical conditions include immune suppression, which would include clients who have had organ transplants and are receiving antirejection medication. Other conditions include acquired immune deficiency syndrome (AIDS) and chronic inflammatory conditions, such as rheumatoid arthritis. Diabetes mellitus and hydrocephalus do not fit into these categories.

Format: Multiple Selection Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 953, Respiratory Pathophysiology: Ventilation and Gas Exchange Disorders 31. The nurse is admitting a client who has been diagnosed with an obstructive respiratory disorder. For which disorders should the nurse assess this client? Select all that apply. A) atelectasis B) cystic fibrosis C) asthma D) pneumonia E) bronchiectasis

Ans: B, C

Feedback: Obstructive disorders of the lower respiratory tract include asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, and respiratory distress syndrome (RDS). Atelectasis is a collapse of once-expanded alveoli. Pneumonia is an infection of the lower respiratory tract. Bronchiectasis is a disorder of chronic infection and inflammation of the bronchial passages.

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Format: Multiple Selection Chapter: 53 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 953, Respiratory Pathophysiology: Pneumonia 32. The nurse is caring for a client who has been diagnosed with pneumonia. Which symptoms would the nurse expect to assess in this client? Select all that apply. A) difficulty breathing B) urinary retention C) rash D) fever E) oxygen saturation of 88% on room air

Ans: A, D, E

Feedback: Symptoms of clients with pneumonia include fever, difficulty breathing, fatigue, noisy breath sounds, and poor oxygenation. Urinary retention and rash are not usual symptoms of pneumonia.

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33. The nurse is teaching about common upper respiratory infections (URIs) to parents of preschool clients. The nurse should cite what examples of URIs? Select all that apply. A) bronchitis B) asthma C) pharyngitis D) sinusitis E) laryngitis

Ans: C, D, E

Feedback: Upper respiratory infections include pharyngitis, sinusitis, and laryngitis. Asthma and bronchitis are examples of lower respiratory disorders.

Format: Multiple Choice Chapter: 53 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 952, Respiratory Pathophysiology: Respiratory Tract Infections: The Common Cold 34. The nurse is assessing a client presenting with nasal congestion, runny nose, sneezing, watery eyes, and scratchy throat. What assessment question would the nurse ask to best evaluate the client’s risk for developing a commonly observed complication? A) “Have you noticed any issues with your vision?” B) “Are you having trouble swallowing? C) “Are you experiencing any ear pain?” D) “How have you been sleeping lately?”

Ans: C

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Feedback: These effects of the “cold” virus can cause the client with a common cold to experience sinus pain, nasal congestion, runny nose, sneezing, watery eyes, scratchy throat, and headache. In susceptible clients, this swelling can often block the outlet of the eustachian tube, which drains the inner ear and equalizes pressure across the tympanic membrane. If this outlet becomes blocked, feelings of ear stuffiness and pain can occur, and the client is more likely to develop otitis media. Watery eyes are a frequent sign of a common cold and could affect the client’s vision, but most visual problems would be unrelated to this type of viral infection. While it would not be inappropriate to assess for difficulty swallowing, it would likely be related to the scratchy throat the client is experiencing rather than a complication of the infection. Sleep is often disrupted by the common symptoms of the common cold and so would not be extremely helpful in identifying complications.

Test Generator Questions, Chapter 54, Drugs Acting on the Upper Respiratory Tract Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 5 Page and Header: 963, Focus on Patient and Family Teaching: Administering Nasal Medications: Nasal Spray, Box 54.2 1. The nurse has taught a client to self-administer a topical decongestant. What statement by the client would indicate additional education is needed? A) “I’ll put the tip of the bottle about half an inch into my nostril.” B) “I’ll squeeze the bottle hard to get the medication into my sinuses.” C) “I’ll sit upright when I give myself the medication.” D) “I won’t take the drug if I’ve got a sore inside my nose.”

Ans: B

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Feedback: The client should not squeeze too forcefully, which could send the medication up into the sinuses; the goal is to keep the medication in the nares. Each of the client’s other three statements reflect safe and effective medication delivery.

Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 974, Expectorants: Pharmacokinetics, Contraindications and Cautions 2. A client calls the clinic and states, “I have had a persistent cough for 2 weeks. What should I do? What would be the nurse’s best response? A) “Look for dextromethorphan as an ingredient in any over-the-counter (OTC) cough preparation.” B) “The probably need an antihistamine to dry up your secretions and stop the cough.” C) “You should come to the clinic to be evaluated. A cough that lasts that long might indicate a medical problem.” D) “Drink a lot of fluids and take an aspirin, which should reduce the irritation in your throat.”

Ans: C

Feedback: A cough that has persisted for 2 weeks could be indicative of an underlying medical condition that should be addressed before treating the cough. The client should be asked to come in for an evaluation. Dextromethorphan could help stop the cough, but suppressing the cough might not be in the client’s best interest. Drying the mucosa with an antihistamine could aggravate the cough. Aspirin would not be indicated for relieving throat irritation.

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Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 977, Mucolytics: Nursing Considerations for Patients Receiving Mucolytics: Nursing Conclusions 3. The nurse is caring for a client who is receiving acetylcysteine by face mask. What would be appropriate for the nurse to assess the client for? A) impaired swallowing B) impaired skin integrity C) onset of falls D) sleep deprivation

Ans: B

Feedback: A client receiving acetylcysteine by face mask should have the residue wiped off the face mask and the client’s face with plain water to prevent skin breakdown. It is appropriate for the nurse to assess the client for impaired skin integrity. Acetylcysteine does not cause impaired swallowing, produce any central nervous system (CNS) effects that could lead to falls, or impair the client’s ability to sleep.

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Page and Header: 977, Mucolytics: Nursing Considerations for Patients Receiving Mucolytics: Intervention with Rationale 4. A nurse is caring for a 15-year-old client who has been diagnosed with cystic fibrosis and has been prescribed dornase alfa. What instruction should the nurse give the client? A) Use in home nebulizer up to every 4 hours. B) Avoid taking other drugs within 2 hours of dornase alfa. C) Store the drug in the refrigerator, protected from light. D) Expect a headache after each use, due to vasodilation.

Ans: C

Feedback: Clients using dornase alfa should be cautioned to store the drug in the refrigerator, protected from light. Heat and light can cause the drug to break down and can decrease its therapeutic value. The drug should only be used up to two times a day, and there is no need to separate this drug from others by 2 hours. Dornase alfa is only a palliative therapy that improves respiratory symptoms. A headache is not associated with this drug.

Format: Multiple Choice Chapter: 54 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 959, Drugs in Focus: Antitussives, Table 54.1 5. A nurse in a pediatric clinic is caring for several clients diagnosed with respiratory illnesses. What medication prescription should the nurse question? A) a 2-year-old client prescribed pseudoephedrine 15 mg by mouth B) a 5-year-old client prescribed hydrocodone 10 mg by mouth C) an 8-year-old client prescribed tetrahydrozoline three drops in each nostril D) a 10-year-old client prescribed diphenhydramine 5 mg/kg intramuscularly

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Ans: B

Feedback: The nurse should question the prescription for hydrocodone. The prescribed dose, 10 mg, is an adult level dose and should not be given to a 5-year-old client. Clients from 2 to 12 years of age should be given between 1.25 and 5 mg/dose. The other medications are all correct dosages for the age of the pediatric clients for whom prescribed.

Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 960, Focus on Drug Therapy Across the Lifespan: Upper Respiratory Tract Agents: Children, Box 54.1 6. The parents of a pediatric client call the nurse stating that they are treating the child’s cold and flu symptoms at home using over-the-counter medications. What guidance should the nurse provide? A) “Read the labels clearly to make sure you’re not giving the same drug in two different preparations.” B) “It is generally safer to give your child herbal preparations rather than over-thecounter drugs.” C) “Many over-the-counter medication preparations do actually not contain any effective drugs.” D) “Over-the-counter medications aren’t recommended for clients who are younger than 12 years of age.”

Ans: A

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Feedback: Parents need to be educated to read the labels of any over-the-counter (OTC) preparation given to pediatric clients. Many of these preparations contain the same ingredients and inadvertent overdose is a common problem. Herbal preparations are not necessarily safer than OTC drugs. All OTC medications contain drugs of some type, and many can be safely given to pediatric clients within the recommended guidelines.

Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 974, Expectorants: Therapeutic Actions and Indications 7. A client presents at the clinic with a dry nonproductive cough. The client is diagnosed with bronchitis, and it has been determined that assistance is needed in thinning the sputum so the cough can become productive. What does the nurse expect the primary health care provider will prescribe? A) benzonatate B) guaifenesin C) dextromethorphan D) hydrocodone

Ans: B

Feedback: Because this client needs to cough up respiratory secretions, the client would likely be prescribed guaifenesin. This drug is an expectorant that liquefies lower respiratory secretions by reducing the viscosity and so making it easier for a client to cough them up. Benzonatate, dextromethorphan, and hydrocodone are antitussives and are given to suppress the cough reflex.

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Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 967, Decongestants: Steroid Nasal Decongestants: Nursing Considerations for Patients Receiving Steroid Nasal Decongestants: Intervention with Rationale 8. A client presents at the clinic with seasonal allergic rhinitis and is prescribed a nasal steroid. Two days later, the client calls the nurse stating, “I am not experiencing any relief.” What is the most appropriate response by the nurse? A) “It may take up to 2 weeks to get the full clinical effect. Try to keep using the drug as prescribed.” B) “The drug must not work for you. I’ll contact your primary health care provider to see if you can change to an oral steroid.” C) “It could be that you are administering the drug incorrectly. Come in and we can review the process.” D) “You probably need to try a different nasal steroid. This one should be effective by now.”

Ans: A

Feedback: Nasal steroids require about 2 weeks to reach their full clinical effect, so the client should be encouraged to use the drug for that length of time before changing drugs or giving up. The other responses could be appropriate if after 2 weeks the client is still not getting relief.

Format: Multiple Choice Chapter: 54

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 971, Antihistamines: Adverse Effects 9. A client has an important presentation to make in 4 hours and needs relief from the congestion of seasonal rhinitis. The client calls the nurse, explains the situation, and tells the nurse, “I cannot afford to be drowsy.” What medication is most likely to meet this client’s needs? A) diphenhydramine B) dexchlorpheniramine C) loratadine D) hydroxyzine

Ans: C

Feedback: The first-generation antihistamines, including diphenhydramine, dexchlorpheniramine, and hydroxyzine, are associated with drowsiness. Loratadine is one of the second-generation antihistamines, which have fewer anticholinergic effects and are less likely to cause drowsiness.

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10. A 71-year-old client with a history of atrial fibrillation, chronic obstructive pulmonary disease, and type 2 diabetes is prescribed an antihistamine. What assessment should the nurse prioritize? A) auscultation of apical heart rate and rhythm B) chest auscultation and assessment of respiratory rate C) assessment of blood glucose levels every 4 hours D) assessment of orientation and level of consciousness

Ans: A

Feedback: Antihistamines have been associated with prolongation of the QT interval, which can lead to potentially fatal cardiac arrhythmias. The client’s history of an arrhythmia heightens the importance of assessing cardiac function. Assessing the client’s blood glucose every 4 hours is likely beyond what is necessary for a client with type 2 diabetes. Respiratory assessment is necessary because of the client’s history of COPD, but antihistamines do not exacerbate this condition. Cognitive changes are not expected.

Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 3, 5 Page and Header: 963, Decongestants: Topical Nasal Decongestants: Nursing Considerations for Patients Receiving Topical Nasal Decongestants: Assessment: History and Examination 11. A 29-year-old client diagnosed with sinusitis is prescribed a topical nasal decongestant. What instructions should the nurse provide to the client? A) “Use two forms of birth control until treatment is complete.” B) “Limit the use of this medication to no more than 5 days.” C) “You need to temporarily avoid foods that are high in sodium.”

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D) “Be sure to take the decongestant medication with meals.”

Ans: B

Feedback: Caution the client not to use the medication for longer than 5 days and to seek medical care if signs and symptoms persist after that time to facilitate detection of underlying medical conditions that may require treatment. The medication does not need to be taken with meals. There is no need to limit sodium intake. Caution is required if the client is pregnant, but requiring two forms of birth control is an excessive precaution.

Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 959, Antitussives: Contraindications and Cautions 12. What statement by a client who is to take an antitussive with codeine indicates the nurse’s teaching has been effective? A) “I will take this medication anytime I start to cough.” B) “This medication may make me anxious and nervous.” C) “I will call my primary health care provider if I have diarrhea.” D) “This medication can cause drowsiness, so I will not drive after I take it.”

Ans: D

Feedback: Codeine is a central nervous system (CNS) depressant and should not be combined with driving or heavy machinery activities. Antitussives are not intended to be taken with every coughing episode because the client may overdose on the medication. The medication usually makes the client drowsy rather than nervous and anxious. Codeine may cause gastrointestinal upset, although it is usually constipating; some

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clients may report nausea and stomach distress while taking this medication, but diarrhea is unusual.

Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 964, Decongestants: Oral Decongestants: Contraindications and Cautions, Adverse Effects 13. The nurse is caring for a client who has been taking an over-the-counter cold remedy containing pseudoephedrine for the past 2 days. What assessment finding should the nurse most likely attribute to this medication? A) nasal congestion and rhinorrhea B) drowsiness and reports of sleeping for 10 hours the previous day C) diaphoresis and oral temperature of 100.2°F (37.9°C) D) heart rate 98 beats/min and blood pressure 142/93 mm Hg

Ans: D

Feedback: Sympathomimetics such as pseudoephedrine cause increased heart rate and blood pressure. These medications do not cause drowsiness; agitation is more likely. A fever or diaphoresis would be attributable to other causes. The drug is intended to relieve cold symptoms; these would not be considered adverse effects. Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning

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Objective: 2 Page and Header: 963, Decongestants: Topical Nasal Decongestants: Adverse Effects 14. The nurse is giving discharge instructions to a client who has been diagnosed with an upper respiratory infection and has been advised to take an over-the-counter (OTC) topical nasal decongestant. What should the nurse teach the client in order to prevent rhinitis medicamentosa? A) Avoid using nonsteroidal antiinflammatory drugs (NSAIDs) concurrently. B) Use the medication for as short a time as possible. C) Do not take antihistamines at the same time as the decongestant. D) Increase fluid intake for the duration of treatment.

Ans: B

Feedback: An adverse effect that accompanies frequent or prolonged use of topical nasal decongestants is rebound congestion, technically called rhinitis medicamentosa. Avoiding the overuse of the medication is a key strategy for preventing this complication. Antihistamines do not cause it, and use of NSAIDs is not problematic. Increasing fluid intake helps with relieving congestion but does not prevent rhinitis medicamentosa.

Format: Multiple Choice Chapter: 54 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 959, Antitussives: Clinically Important Drug–Drug Interactions 15. The nurse is caring for a client who states, “I recently took dextromethorphan for cough suppression.” The nurse should contact the primary health care provider promptly if the client also takes which other medication? A) verapamil

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B) phenelzine C) metoprolol D) hydrochlorothiazide

Ans: B

Feedback: Dextromethorphan should not be used in conjunction with MAO inhibitors like phenelzine because hypotension, fever, nausea, myoclonic jerks, and coma could occur. No known drug–drug interaction exists between dextromethorphan and calcium channel blockers, beta-blockers, and thiazide diuretics.

Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 973, Antihistamines: Nursing Considerations for Patients Receiving Antihistamines: Intervention with Rationale 16. A client has begun taking an antihistamine for the treatment of seasonal allergies. What dietary guidelines should the nurse provide to the client? A) Do not drink alcohol while taking antihistamines. B) Avoid grapefruit juice until at least 48 hours after treatment is complete. C) Increase intake of foods that are high in vitamin C. D) Eat several small meals instead of three larger meals a day.

Ans: A

Feedback: Alcohol is contraindicated during treatment with antihistamines due to the sedative effects that can be compounded by alcohol. There is no need to change the

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client’s eating schedule or to avoid grapefruit juice. Vitamin C intake does not need to be increased.

Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 3, 4 Page and Header: 975, Mucolytics: Therapeutic Actions and Indications 17. The nurse is caring for a client who does not have a respiratory disorder but has been prescribed acetylcysteine. What is an additional indication for acetylcysteine? A) conversion of cardiac dysrhythmias B) treatment of peptic ulcer disease C) antidote for acetaminophen poisoning D) treatment of bronchospasm

Ans: C

Feedback: Acetylcysteine is used orally to protect liver cells from being damaged during episodes of acetaminophen toxicity because it normalizes hepatic glutathione levels and binds with a reactive hepatotoxic metabolite of acetaminophen. Acetylcysteine is not used for the conversion of cardiac dysrhythmias, for treatment of peptic ulcer disease, or for decreasing bronchospasm.

Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 5 Page and Header: 971, Antihistamines: Adverse Effects 18. A client with seasonal allergies has sought care due to a recent onset of blurred vision and urinary retention. What is the nurse’s best action? A) Recommend the client talk to the primary health care provider. B) Determine whether the client is taking over-the-counter antitussives. C) Assess the client’s pattern of antihistamine usage. D) Perform a focused respiratory assessment.

Ans: C

Feedback: The client’s report suggests anticholinergic effects, which can result from antihistamines. Antitussives do not cause anticholinergic effects. There is no obvious indication that a focused respiratory assessment is necessary. The nurse should not defer to the client’s primary health care provider until performing a nursing assessment, including medication use.

Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 2 Page and Header: 963, Decongestants: Topical Nasal Decongestants: Adverse Effects 19. The nurse advises a client to avoid long-term use of nasal decongestants because it may lead to what condition? A) mucosal ulcerations B) decreased drainage C) increased risk of infection D) asthma

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Ans: A

Feedback: Adverse effects associated with topical decongestants include local stinging and burning, which may occur the first few times the drug is used. If the sensation does not resolve, the drug should be discontinued, because it may indicate lesions or erosion of the mucous membranes. Nasal decongestants do not cause asthma or increased risk of infection. These medications do not decrease drainage from the nose as they shrink the nasal mucosa.

Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 963, Nursing Considerations for Patients Receiving Topical Nasal Decongestants: Assessment: History and Examination 20. The nurse is caring for a client who has been diagnosed with an upper respiratory infection and is inquiring about the use of nasal decongestants. What comorbidity would require cautious use of decongestants? A) Reynaud’s syndrome B) rheumatoid arthritis C) gastroesophageal reflux disease (GERD) D) hypothyroidism

Ans: D

Feedback: Thyroid disease could be exacerbated by the sympathomimetic effects of nasal decongestants. Nasal decongestants do not appear to exacerbate Reynaud’s syndrome, rheumatoid arthritis, or GERD.

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Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 966, Decongestants: Oral Decongestants: Intervention with Rationale 21. The nurse is providing education for a client who is taking multiple over-the-counter (OTC) combination cold medications. What are these medications most likely to contain? A) stimulants B) opioids C) oral decongestants D) antihistamines

Ans: C

Feedback: Oral decongestants are found in many OTC cold and flu preparations, so care must be taken to avoid inadvertent overdose when more than one such drug is used. Opioids are only available by prescription; stimulants and antihistamines are not generally found in OTC combination cold medications.

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Page and Header: 962, Decongestants: Topical Nasal Decongestants: Therapeutic Actions and Indications 22. A client is diagnosed with acute sinusitis. To promote sinus drainage, what medication will the nurse anticipate being prescribed for this client? A) topical nasal steroid decongestants B) first-generation antihistamines C) second-generation antihistamines D) topical decongestants

Ans: D

Feedback: Topical decongestants are sympathomimetics, meaning that they imitate the effects of the sympathetic nervous system to cause vasoconstriction, leading to decreased edema and reduced inflammation of the nasal membranes. They are available as nasal sprays that are used to relieve the discomfort of nasal congestion that accompanies the common cold, sinusitis, and allergic rhinitis. Topical nasal steroid decongestants are used for the treatment of allergic rhinitis and to relieve inflammation after the removal of nasal polyps. First- and second-generation antihistamines are not ordered for sinusitis.

Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 967, Antihistamines 23. The nurse is caring for a client who has been diagnosed with allergic rhinitis and takes clemastine daily. What should the nurse teach the client about the action of the medication? A) It blocks the effects of histamine.

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B) It changes the viscosity of mucus. C) It promotes the development of mast cells. D) It increases the tone of smooth muscle in the bronchi.

Ans: A

Feedback: Clemastine blocks the effects of histamine at the histamine-1 receptor sites, decreasing the allergic response. It is prescribed to treat allergic rhinitis. Antihistamines do not directly change the viscosity or secretions or promote mast cell development. Antihistamines do not increase bronchial muscle tone.

Ans: D

Feedback: An adverse effect that accompanies frequent or prolonged use of decongestants is rebound vasodilation, clinically called rhinitis medicamentosa. The reflex reaction to vasoconstriction is a rebound vasodilation, which often leads to prolonged overuse of decongestants. The client should hold the head back for maximum

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distribution of the spray. Only one individual client should use the bottle of medication. The same bottle should not be shared.

Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3, 4 Page and Header: 971, Antihistamines: Clinically Important Drug–Drug Interactions 25. The nurse is caring for a client who has been prescribed fexofenadine for hay fever. When the nurse is assessing this client’s medication history, what drug would make the nurse question the prescription? A) tetracycline B) penicillin C) gentamicin D) ketoconazole

Ans: D

Feedback: Drug–drug interactions vary among antihistamines. For example, anticholinergic effects may be prolonged if diphenhydramine is taken with a monoamine inhibitor, and the interaction of fexofenadine with ketoconazole or erythromycin may raise fexofenadine concentrations to toxic levels. This is not a concern with tetracycline, penicillin, or gentamicin.

Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 958, Antitussives 26. A client has been diagnosed with chronic pharyngitis. The nurse knows the client is most likely to benefit from what medication category? A) antitussives B) nasal sprays C) oral decongestants D) mucolytics

Ans: A

Feedback: Antitussives are drugs that suppress the cough reflex. Many disorders involving the respiratory tract, including the common cold, sinusitis, pharyngitis, and pneumonia, are accompanied by an uncomfortable, nonproductive cough. Persistent coughing can be exhausting and can cause muscle strain and further irritation of the respiratory tract. Nasal sprays, oral decongestants, and mucolytics are not generally prescribed for chronic pharyngitis, however.

Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 965, Decongestants: Oral Decongestants: Clinically Important Drug– Drug Interactions 27. The nurse is teaching a group of clients who have been diagnosed with allergic rhinitis about medication use. What would be the most essential information to give these clients about preventing possible drug interactions?

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A) Over-the-counter (OTC) medications are safe to use. B) Use only one pharmacy so the pharmacist can check drug interactions. C) Read drug labels before taking OTC medications. D) Ask a health care professional for assistance in selecting an OTC medication.

Ans: C

Feedback: Teach clients to read the OTC labels to avoid inadvertent overdose. It would be inappropriate to teach the client to use only one pharmacy for OTC medications. OTC medications are generally safe to use if used correctly. Asking a health care professional for help in selecting an OTC medication is appropriate but not the most essential information to give the clients. Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 966, Decongestants: Steroid Nasal Decongestants: Therapeutic Actions and Indications 28. Which client is most likely to benefit from the administration of a nasal steroid? A) a client with an acute sinus infection B) a client who has chronic allergic rhinitis C) a client who is recovering from a tonsillectomy D) a client who has a deviated nasal septum

Ans: B

Feedback: Because nasal steroids block the inflammatory response, their use is contraindicated in the presence of acute infections. The most common reason they are prescribed is for the treatment of allergic rhinitis or to relieve inflammation after the

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removal of nasal polyps. Nasal steroids are not used for treatment after a tonsillectomy or for clients with a deviated nasal septum.

Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 967, Decongestants: Steroid Nasal Decongestants: Nursing Considerations for Patients Receiving Steroid Nasal Decongestants: Nursing Conclusions 29. The nurse is developing a care plan for a client who has been prescribed a nasal steroid. What would be an appropriate nursing diagnosis for this client? A) disturbed kinesthetic sensory perception related to central nervous system effects B) risk for injury related to suppression of inflammatory reaction C) ineffective airway clearance related to bronchospasm D) ineffective airway related to nasal obstruction

Ans: B

Feedback: Nursing diagnoses related to drug therapy might include acute pain related to local effects of the drug, risk for injury related to suppression of inflammatory reaction, and deficient knowledge regarding drug therapy. Nursing diagnosis for this client does not include disturbed sensory perception, ineffective airway clearance, or ineffective airway.

Format: Multiple Choice Chapter: 54 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 961, Antitussives: Nursing Considerations for Patients Receiving Antitussives: Intervention with Rationale 30. The nurse is caring for a client who has been noncompliant with the care regimen the primary health care provider previously prescribed for treatment of sinusitis. What should the nurse do to best promote compliance? A) Assess the reasons why the client did not comply with treatment. B) Provide the instructions in large type. C) Give the treatment instructions to a member of the client’s family. D) Ensure that the client’s spouse has and understands the treatment instructions.

Ans: A

Feedback: Before performing any interventions, it is important that the nurse assess the reasons why the client did not comply. These findings would inform the nurse’s choice of subsequent interventions. Giving the client instructions in large print may not be related to the reason for noncompliance. Giving the instructions to a family member or spouse does not address the reason for noncompliance. Other members of the client’s family may be included in the care and education if found to be needed following assessment of noncompliance.

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31. The nurse is caring for a client who has been diagnosed with cystic fibrosis and is receiving dornase alfa by nebulizer to help thin secretions. What statement by the client indicates a need for further instruction? A) “This medication will loosen up the sticky mucus in my lungs.” B) “I will try to cough after I receive this medication.” C) “I’m glad this medication will address all of my symptoms.” D) “I will continue to use postural drainage and take my enzymes.”

Ans: C

Feedback: Cystic fibrosis clients who receive dornase alfa should be cautioned about the need to continue all therapies for their cystic fibrosis because dornase alfa is only a palliative therapy that improves respiratory symptoms, and other therapies, such as coughing, postural drainage, and enzymes, are still needed. This medication will not relieve all of the client’s symptoms.

Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 975, Mucolytics: Contraindications and Cautions 32. The nurse is caring for a client who is scheduled to receive acetylcysteine. The nurse should notify the primary health care provider before administering the medication if the client has which conditions? A) bronchospasm B) hypertension C) nephrotic syndrome D) peptic ulcer

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Ans: A

Feedback: Before administration, assess for possible contraindications or cautions: any history or allergy to the prescribed drugs and the presence of bronchospasm, which are contraindications to the use of these drugs. None of the other options are contraindicated.

Format: Multiple Selection Chapter: 54 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 974, Expectorants: Adverse Effects 33. A client has been using guaifenesin for a cough that accompanied a common cold. The client calls the nurse and states, “I think I am having an adverse reaction to the medication.” The nurse knows which symptoms are adverse effects of this medication? Select all that apply. A) nausea B) rash C) constipation D) bleeding E) headache

Ans: A, B, E

Feedback: Adverse effects of guaifenesin are nausea, vomiting, headache, dizziness, and rash. Constipation and bleeding are not adverse effects of guaifenesin.

Format: Multiple Selection Chapter: 54

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 973, Antihistamines: Nursing Considerations for Clients Receiving Antihistamines: Intervention with Rationale 34. A client is prescribed an antihistamine for the treatment of allergic rhinitis. What statements by the client indicate an understanding of the nurse’s teaching about this medication? Select all that apply. A) “This medication will work best if I take it when I eat.” B) “I need to drink less fluid while I take this medication.” C) “I will suck on sugarless candies to help with the feelings of a dry mouth.” D) “I will use a humidifier in the bedroom while I sleep.” E) “This medication will probably cause my appetite to increase.”

Ans: C, D

Feedback: Antihistamines should be taken on an empty stomach, and the client should force fluids, not drink less fluids. The client may suck on or eat sugarless candy to help with dry mouth and should increase room humidity. The client may experience nausea or anorexia but not increased hunger.

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35. The nurse is caring for a client who is taking diphenhydramine. What potential indications may this drug be used for? Select all that apply. A) urticaria B) vasomotor rhinitis C) productive cough D) motion sickness E) angioedema

Ans: A, B, D, E

Feedback: Diphenhydramine is used for the symptomatic relief of perennial and seasonal rhinitis, vasomotor rhinitis, allergic conjunctivitis, urticaria, and angioedema; it is also used for treating motion sickness and parkinsonism, as a nighttime sleep aid, and to suppress cough. It would not be used to treat a productive cough, because it is not an expectorant. Format: Multiple Choice Chapter: 54 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 960, Focus on Drug Therapy Across the Lifespan: Upper Respiratory Tract Agents: Older Adults, Box 54.1 36. The nurse is preparing to educate an older adult client encouraged to take an overthe-counter (OTC) medication to help manage the symptoms of a common cold. What education should the nurse stress when addressing the most common adverse effect associated with these drugs? A) “Drink a liter or more of fluid daily while taking the medication.” B) “Strictly follow the dosage recommendations provided with the medication.” C) “Move cautiously when changing from a sitting to standing position.” D) “Be sure to sleep in a semi-inclined position while taking this medication.”

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Ans: C

Feedback: Older adult clients are frequently prescribed one of these drugs. It is common for older adult clients to develop adverse effects associated with the use of these drugs, including sedation, confusion, and dizziness. Safety measures may be needed if these effects interfere with the client’s mobility and balance. Hydration directly related to electrolyte imbalance, and dosage recommendations are appropriate but not related to the most common adverse effect, dizziness. Sleeping in a semi-inclined or sitting position is helpful if doing so helps lessen the effect of the nasal congestion on breathing.

Test Generator Questions, Chapter 55, Drugs Acting on the Lower Respiratory Tract Format: Multiple Choice Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 986, Bronchodilators: Clinically Important Drug–Drug Interactions 1. A 70-year-old client is being treated for chronic obstructive pulmonary disease (COPD) with theophylline. What will be a priority assessment by the nurse? A) intake of fatty foods B) weight C) activity level D) use of nicotine

Ans: D

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Feedback: Nutritional status, weight, and activity level would be important for a nurse to know about a COPD client. However, it would be most important for the nurse to know whether the client smokes or uses tobacco in other ways or smoking cessation methods that involve nicotine. Nicotine increases the metabolism of theophyllines; the dosage may need to be increased to produce a therapeutic effect.

Format: Fill-in-the-Blank Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 983, Drugs in Focus: Bronchodilators, Table 55.1 2. A 6-year-old pediatric client weighing 52 lb (23.6 kg) has had a loading dose of aminophylline. The nurse is ready to administer the regular prescribed dose of 4 mg/kg every 4 hours for three doses. How many milligrams should the client receive in 12 hours? Round the answer to the nearest whole number.

Ans: 284 mg

Feedback: First, using the formula of amount of drug prescribed times weight in kilograms, determine the amount the child will receive in one dose (4 times 23.6 = 94.5). To determine the milligrams in a 12-hour period, multiply 94.5 times 3 = 283.68. Round to 284 mg.

Format: Multiple Choice Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 986, Bronchodilators: Adverse Effects 3. A client is in the clinic to have blood drawn to assess theophylline levels. The client appears to being responding well to the medication and is not experiencing any adverse effects. What serum level will the nurse expect the client to have? A) Between 0.5 and 5 mcg/mL (2.78 and 27.75 µmol/L) B) Between 10 and 20 mcg/mL (55.51 and 111.01 µmol/L) C) Between 25 and 35 mcg/mL (138.76 and 194.27 µmol/L) D) Between 40 and 50 mcg/mL (222.02 and 277.52 µmol/L)

Ans: B

Feedback: Therapeutic theophylline levels should be between 10 and 20 mcg/mL (55.51 and 111.01 µmol/L). A level between 0.5 and 5 mcg/mL (2.78 and 27.75 µmol/L) would be low and would not produce a therapeutic effect. Levels between 25 and 50 mcg/mL (138.76 and 277.52 µmol/L) would be too high and could cause serious adverse effects.

Format: Multiple Choice Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 1, 2 Page and Header: 989, Bronchodilators: Sympathomimetics 4. A client having an acute asthma attack is prescribed epinephrine. The nurse should assess what therapeutic effect of this drug? A) decreased inflammatory response in the airways B) reduced surface tension within the alveoli allowing for gas exchange C) inhibition of histamine and slow-reacting substance of anaphylaxis (SRSA) D) dilation of the bronchi with increased rate and depth of respiration

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Ans: D

Feedback: Epinephrine will cause the bronchi to dilate and also cause the rate and depth of respiration to increase. Inhaled steroids decrease the inflammatory response, and lung surfactants reduce the surface tension within the alveoli. Mast cell stabilizers inhibit the release of histamine and SRSA to prevent the allergic response.

Format: Multiple Choice Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 991, Bronchodilators: Sympathomimetics: Nursing Considerations for Patients Receiving Sympathomimetics: Intervention with Rationale 5. An inhaled sympathomimetic drug has been prescribed for a teenage client who has been diagnosed with exercise-induced asthma. What should the nurse instruct the client to do? A) Use the inhaler every day at the same time each day. B) Use the inhaler as soon as the symptoms start. C) Use the inhaler 30 to 60 minutes before exercising. D) Use the inhaler 2 to 3 hours before exercising to ensure peak effectiveness.

Ans: C

Feedback: Teaching a client about using an inhaled sympathomimetic for management of exercise-induced asthma should include instructions to use the inhaler 30 to 60 minutes before exercising to ensure therapeutic levels when needed. The inhaler would not be used daily and waiting until symptoms occur will be too late for prevention.

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Format: Multiple Choice Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 1001, Lung Surfactants: Prototype Summary: Beractant 6. The nurse is caring for a premature newborn client being treated for respiratory distress syndrome. What action should the nurse perform in anticipation of beractant administration? A) Establish reliable intravenous access. B) Temporarily discontinue the client’s oxygen therapy. C) Review the client’s bilirubin and liver enzyme levels. D) Position the client for intratracheal administration.

Ans: D

Feedback: Beractant is administered intratracheally, not intravenously. It would be unsafe and unnecessary to discontinue the client’s supplementary oxygen. Liver enzyme levels are not a priority during this time of acute distress.

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7. A client who has chronic bronchial asthma has had a mast cell stabilizer prescribed. The nurse would anticipate providing education on which medication? A) ipratropium B) isoetharine C) cromolyn D) aminophylline

Ans: C

Feedback: Cromolyn is the only mast cell stabilizer used in the treatment of asthma. Aminophylline is a xanthine. Ipratropium is an anticholinergic drug. Isoetharine is a sympathomimetic drug.

Format: Multiple Choice Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 991, Bronchodilators: Anticholinergics: Contraindications and Cautions 8. A 76-year-old client diagnosed with COPD has been taking ipratropium. The nurse knows what change in the client’s health status is most likely to require a change in the client’s drug regimen? A) The client begins taking a diuretic for hypertension. B) The client is diagnosed with benign prostatic hypertrophy. C) The client loses 15 lb (6.8 kg) over 8 weeks. D) The client develops a venous ulcer.

Ans: B

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Feedback: Anticholinergics can produce urinary hesitancy and urinary retention, conditions that would aggravate the signs and symptoms of prostatic hypertrophy. Weight loss, venous ulcers, and the use of diuretics do not contraindicate the safe use of anticholinergics.

Format: Multiple Selection Chapter: 55 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 3, 5 Page and Header: 998, Drugs Affecting Inflammation: Leukotriene Receptor Antagonists: Clinically Important Drug–Drug Interactions 9. A client with chronic bronchial asthma is prescribed montelukast. What will the nurse instruct the client to avoid taking along with this medication? Select all that apply. A) aspirin B) theophylline C) sertraline D) phenytoin E) warfarin

Ans: A, B, D, E

Feedback: The nurse would instruct the client to avoid aspirin, warfarin, theophylline, and phenytoin, which might cause an increased montelukast level and toxicity. Sertraline is not known to cause a drug–drug interaction with montelukast.

Format: Multiple Choice Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

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Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 991, Nursing Considerations for Patients Receiving Sympathomimetics: Intervention with Rationale; 992, Focus on Patient and Family Teaching: Teaching Patients to Self-Administer Medication: Nebulizers, Box 55.5 10. A client diagnosed with chronic obstructive pulmonary disease has been prescribed bronchodilators by nebulizer for home use. What should the nurse teach the client to do to best assure effective use of the nebulizer? A) Keep an extra oxygen tank on hand for propelling the medication. B) Sit in a fully upright position when administering the medication. C) Take the exact number of puffs that have been prescribed. D) Gargle with an alcohol-based mouthwash after each dose.

Ans: B

Feedback: Clients should sit in Fowler’s position when inhaling nebulized medications. Compressed air (not oxygen) is used. Inhalers require a prescribed number of “puffs,” not nebulizers. The client should rinse the mouth after administration, but an alcoholbased solution is not necessary.

Format: Multiple Selection Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 983, Drugs in Focus: Bronchodilators, Table 55.1 11. A client diagnosed with asthma is prescribed tiotropium. What should the nurse teach the client about this drug? Select all that apply.

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A) “It will likely make you fatigued.” B) “You need to stay out of direct sunlight.” C) “It is an anticholinergic.” D) “You only need to take it once a day.” E) “It has a rapid onset of action and a long duration.”

Ans: C, D, E

Feedback: Tiotropium is an anticholinergic that has a rapid onset of action and a long duration, with a half-life of 5 to 6 days. Tiotropium is not associated with fatigue or photosensitivity. It is taken once per day.

Format: Multiple Choice Chapter: 55 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1, 3, 5 Page and Header: 985, Enzyme Therapy: Alpha1-Protease Inhibitor (Human), Box 55.3 12. The nurse provides care for a client who presents to the clinic once per week to receive a dose of alpha1-protease inhibitor (human). When planning the client’s assessments, what basic understanding should guide the nursing care? A) The client has a genetic predisposition to severe asthma. B) The client is a lung transplant recipient. C) The client has chronic obstructive pulmonary lung disease that has not responded to other therapies. D) The client has a high risk of emphysema.

Ans: D

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Feedback: Alpha1-protease inhibitor (human) is used for the treatment of alpha1protease deficiency, a chronic, hereditary, autosomal dominant disorder that presents as progressive, severe emphysema, usually during a person’s 30s or 40s. It is not used post-lung transplant or for the treatment of chronic obstructive pulmonary lung disease.

Format: Multiple Choice Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 5 Page and Header: 991, Nursing Considerations for Patients Receiving Sympathomimetics: Intervention with Rationale; 992, Focus on Patient and Family Teaching: Teaching Patients to Self-Administer Medication: Inhaler, Box 55.5 13. What action by the client would indicate to the nurse that the client understands how to use an inhaler? A) The client inhales as soon as the inhaler enters the mouth. B) The client holds their breath as long as possible after depressing the canister. C) The client uses a spacer to administer a powdered medication. D) The client exhales as soon as the inhaler is compressed.

Ans: B

Feedback: Holding the breath prevents exhalation of medication still remaining in the mouth. The client should inhale when the canister is compressed, not as soon as the inhaler enters the mouth. The client should only administer one dose of medication at a time, and the client should wait to exhale until after the breath has been held as long as possible. Spacers are not used with powdered medications.

Format: Multiple Choice

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Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 981, Introduction 14. A client, newly diagnosed with chronic obstructive pulmonary disease (COPD), asks the nurse to explain what the newly prescribed medications are for. What would be the most appropriate response by the nurse? A) “The medications that have been prescribed for you are what the primary health care provider thinks will help your breathing the most.” B) “The medications that have been prescribed for you are to help you breathe with less resistance from your diaphragm.” C) “The medications that have been prescribed for you are designed to work together to reduce your oxygen requirements.” D) “The medications that have been prescribed for you are to help relieve the inflammation and open your airways.”

Ans: D

Feedback: Drug treatment of asthma and COPD aims to relieve inflammation and promote bronchial dilation. Drugs affecting the lower airway do not normally affect the diaphragm. These drugs do not reduce the body’s oxygen demand. Stating that the primary health care provider thinks these medications are best is not a sufficient or helpful response. Format: Multiple Choice Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2

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Page and Header: 985, Bronchodilators: Contraindications and Cautions 15. The nurse is caring for a client who is taking a bronchodilator. In what disease process should bronchodilators be used cautiously? A) liver failure B) renal failure C) respiratory failure D) heart failure

Ans: D

Feedback: Adrenergic drugs cause cardiac stimulation and may be contraindicated in heart failure. Clients with liver failure, renal failure, or respiratory failure do not need to use adrenergic bronchodilators cautiously.

Format: Multiple Choice Chapter: 55 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 3, 5 Page and Header: 986, Bronchodilators: Clinically Important Drug–Drug Interactions 16. The 34-year-old client has recently started taking theophylline. The nurse knows medication teaching has been successful when the client agrees to what activity? A) avoiding beverages that contain caffeine B) eating foods high in potassium C) limiting fluid intake to 1,000 mL a day D) taking the medication on an empty stomach

Ans: A

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Feedback: Both theophylline and caffeine are xanthenes. Theophylline increases cardiac output and heart rate. Caffeine also stimulates heart rate. This can have an additive effect. Eating foods high in potassium, limiting fluid intake, or taking the medicine on an empty stomach are not indications that the client has understood the nurse’s teaching.

Format: Multiple Choice Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 990, Bronchodilators: Sympathomimetics: Adverse Effects 17. The nurse is caring for a 38-year-old client who has been diagnosed with asthma and is prescribed albuterol. What assessment finding should the nurse most likely attribute to adverse medication effects? A) The client reports excessive thirst. B) The client’s heart rate is 99 beats/min. C) The client’s oral temperature is 100°F (37.8°C). D) The client had diarrhea this morning. Ans: B

Feedback: Adverse effects of these drugs, which can be attributed to sympathomimetic stimulation, include central nervous system (CNS) stimulation, gastrointestinal upset, cardiac arrhythmias, hypertension, angina, sweating, pallor, and flushing. Adrenergic agents do not cause polydipsia, fever, or diarrhea.

Format: Multiple Choice Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 983, Drugs in Focus: Bronchodilators, Table 55.1 18. The nurse is caring for a client who is experiencing an acute bronchospasm. What drug is most likely to meet this client’s needs? A) ipratropium bromide B) epinephrine C) cromolyn D) ephedrine

Ans: B

Feedback: Epinephrine may be injected subcutaneously in an acute attack of bronchoconstriction, with therapeutic effects in 5 minutes that last 4 hours. It is considered the drug of choice for the treatment of acute bronchospasm. Ipratropium bromide has an onset of action of 15 minutes when inhaled with a duration of 3 to 4 hours. Cromolyn is not for use during acute times of bronchospasm but is used to help prevent bronchospasm. Ephedrine can be used in acute bronchospasm, but epinephrine remains the drug of choice. Format: Multiple Choice Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 991, Nursing Considerations for Patients Receiving Sympathomimetics: Intervention with Rationale; 992, Focus on Patient and Family Teaching: Teaching Patients to Self-Administer Medication, Box 55.5 19. The nurse has provided teaching to a 15-year-old client who has been newly diagnosed with asthma. What statement, made by the client, indicates understanding of the teaching the nurse has given on inhalers?

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A) “I should hold my breath when administering a puff.” B) “Not all aerosol canister should be shaken well before using.” C) “I need to take three short quick breaths when I use the inhaler.” D) “I should insert the inhaler around one inch into my mouth.”

Ans: B

Feedback: Not all inhalers should be shaken well, immediately before each use. It is important to read the instructions carefully. It would not be appropriate to teach the client to hold the breath when administering a puff because this would inhibit inhalation. The client should hold the device around one inch from the open mouth, not inside it. There is no need to take three quick breaths.

Format: Multiple Choice Chapter: 55 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 999, Drugs Affecting Inflammation: Immune Modulators: Contraindications and Cautions 20. A nurse cares for several clients who have asthma. Which client should the nurse monitor most closely because of a heightened risk for anaphylaxis? A) a client of Asian descent with a history of cigarette smoking B) a 17-year-old client who experiences exercise-induced asthma C) a 76-year-old client who takes theophylline D) a client of African descent taking omalizumab

Ans: D

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Feedback: Omalizumab has a warning addressing a small but significant increase in the risk of a life-threatening anaphylaxis episodes in clients using the drug. None of the other options are associated with anaphylaxis.

Format: Multiple Choice Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 4 Page and Header: 983, Drugs in Focus: Bronchodilators, Table 55.1 21. The nurse is caring for a client who has an acute attack of bronchoconstriction. What information will the nurse provide the client regarding treatment? A) Short-acting bronchodilators are the drug of choice in this situation. B) Epinephrine is the drug of choice in this situation. C) Self-administered metered-dose inhalers (MDIs) are safest and effective. D) Long-acting beta2-adrenergic agonists (LABAs) are the first-line treatment. Ans: B

Feedback: Epinephrine, the prototype drug, is the drug of choice for the treatment of acute bronchospasm, including that caused by anaphylaxis; it is also available for inhalation therapy. Because epinephrine is associated with systemic sympathomimetic effects, it is not the drug of choice for clients with cardiac conditions.

Format: Multiple Choice Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process

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Objective: 3, 5 Page and Header: 983, Drugs in Focus: Bronchodilators, Table 55.1 22. The nurse is reviewing the medication regimen of a client. The nurse notes that the client takes sustained-release theophylline. When planning the client’s care, the nurse should address what characteristic of this client’s asthma? A) The client likely experiences several asthma exacerbations each day. B) The client likely has asthma symptoms occurring frequently. C) The client likely experiences asthma symptoms a few times each week. D) The client was likely diagnosed with asthma several months ago.

Ans: B

Feedback: Sustained-release theophylline is used for mild persistent asthma, in which the client has symptoms at least once per week but not every day. There is no way of knowing when the client was first diagnosed based on the information provided.

Format: Multiple Choice Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 983, Drugs in Focus: Bronchodilators, Table 55.1 23. The nurse is caring for a client who has been prescribed salmeterol with dosage on a 4- to 6-hour schedule for treatment of exercise-induced asthma. What is the recommended dosing schedule for clients with asthma to prevent dyspnea during exercise? A) thirty minutes before exercise B) immediately before and after exercise C) as needed during exercise D) every 1 to 2 hours during exercise

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Ans: A

Feedback: Clients 12 years of age and older should take one puff of salmeterol every 12 hours or one puff 30 minutes before exercise.

Format: Multiple Choice Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1, 2 Page and Header: 994, Drugs Affecting Inflammation 24. A client with asthma has been prescribed an antiinflammatory medication. The client asks the nurse, “How does an antiinflammatory drug reduce my bronchoconstriction?” Which information will the nurse include in the response? A) It increases the ability to metabolize medication. B) It decreases the formation of mucous secretions. C) It increases the uptake of corticosteroids to medication. D) It decreases airway hyperreactivity to stimuli.

Ans: D

Feedback: Bronchodilators, or antiasthmatics, are medications used to facilitate respirations by dilating the airways. They are helpful in symptomatic relief or prevention of bronchial asthma and for bronchospasm associated with chronic obstructive pulmonary disease (COPD). Reducing inflammation prevents and reduces bronchoconstriction by decreasing airway hyperreactivity to various stimuli that decreases mucosal edema and formation of mucous secretions that narrow airways. Antiinflammatory drugs do not increase the ability to metabolize medication or increase uptake of steroids.

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Format: Multiple Choice Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 996, Drugs Affecting Inflammation: Inhaled Steroids: Contraindications and Cautions 25. A client has been diagnosed with asthma and prescribed inhaled steroids. What should the nurse teach the client about this treatment? A) Inhaled corticosteroids should not be used on an emergency basis. B) Effective levels are usually reached within 72 hours of starting treatment. C) Systemic adverse effects should be expected and can be serious. D) The drug will stimulate the sympathetic nervous system.

Ans: A

Feedback: Inhaled steroids are not for emergency use and not for use during an acute asthma attack or status asthmaticus. They do not stimulate the sympathetic nervous system. Because of the route of administration, systemic side effects are uncommon. Effective levels may take 2 to 3 weeks to be reached.

Format: Multiple Choice Chapter: 55 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1, 5 Page and Header: 981, Introduction

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26. The nurse is caring for a client who has been diagnosed with chronic obstructive pulmonary disease (COPD). The plan of care will focus on what client problem? A) risk for aspiration B) lack of patent airway C) activity intolerance D) adverse effects of medication therapy

Ans: B

Feedback: Asthma, emphysema, COPD, and respiratory distress syndrome (RDS) are pulmonary obstructive diseases. All but RDS involve obstruction of the major airways. RDS obstructs the alveoli. Pain, activity intolerance, and adverse effects of medication therapy are conditions identified to detect, manage, and minimize the unexpected outcomes the nurse should be especially aware of the potential for an obstructed airway in these clients.

Format: Multiple Choice Chapter: 55 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 981, Introduction 27. The nurse is caring for a client who has been newly diagnosed with chronic obstructive pulmonary disease (COPD). The client asks the nurse what COPD means. What would be the nurse’s best response? A) “Chronic obstructive pulmonary disease is an umbrella term for diseases like acute bronchitis.” B) “It means the lungs have been damaged in such a way that airflow is limited in and out of the lungs.”

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C) “It means your lungs can’t expand and contract like they are supposed to, which makes it hard for you to breathe.” D) “It is a term that covers so many lung diseases that all affect your breathing.”

Ans: B

Feedback: The obstruction of asthma, emphysema, and COPD can be related to inflammation that results in narrowing of the interior of the airway and to muscular constriction that results in narrowing of the conducting tube. With chronic inflammation, muscular and cilial action is lost, and complications related to the loss of these protective processes can occur, such as infections, pneumonia, and movement of inhaled substances deep into the respiratory system. In severe COPD, air is trapped in the lower respiratory tract, the alveoli degenerate and fuse together, and the exchange of gases is greatly impaired.

Format: Multiple Selection Chapter: 55 Client Needs: Health Promotion and Maintenance Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 3, 5 Page and Header: 982, Maintenance Treatment of Asthma, Box 55.2 28. The nurse is caring for a pediatric client who has been newly diagnosed with asthma. What environmental modifications should the nurse encourage the parents to make to help the client avoid future attacks? Select all that apply. A) Make sure the client begins herbal therapy as soon as possible. B) Avoid crowded areas as much as possible. C) Keep the client away from any known allergens. D) Encourage the client to maximize physical activity. E) Keep the client away from areas that are filled with cigarette smoke.

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Ans: B, C, E

Feedback: Parents need to be encouraged to take measures to prevent acute attacks, including avoidance of known allergens, smoke-filled rooms, and crowded or dusty areas. OTC drugs and herbal remedies should be avoided if possible. The client should perform physical activity within personal limits, but it is not necessary to perform it to maximum limits, which could exacerbate symptoms.

Format: Multiple Selection Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 982, Maintenance Treatment of Asthma, Box 55.2 29. The nurse provides care for numerous pediatric clients diagnosed with asthma. The nurse should expect to administer what drug to these clients? Select all that apply. A) long-acting inhaled steroids B) xanthines C) leukotriene-receptor antagonists D) topical steroid nasal decongestants E) short-acting Beta2-agonists

Ans: A, C, E

Feedback: Antiasthmatics are frequently used in children. The leukotriene-receptor antagonists have been found to be especially effective for long-term prophylaxis in pediatric clients. Acute episodes are best treated with a beta-agonist and then a longacting inhaled steroid or a mast cell stabilizer. Xanthines (e.g., theophylline) have been used in pediatric clients, but because of their many adverse effects and the better control afforded by newer agents, its use is reserved for clients who do not respond to

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other therapies. Topical steroid nasal decongestants may be used for symptom relief for nasal congestion but are not a regular part of asthma therapy in pediatric clients.

Format: Multiple Selection Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Difficult Integrated Process: Nursing Process Objective: 2, 3, 5 Page and Header: 998, Drugs Affecting Inflammation: Leukotriene Receptor Antagonists: Clinically Important Drug–Drug Interactions 30. The nurse is caring for a client who has been diagnosed with asthma and prescribed zafirlukast. The nurse would hold the medication and contact the primary health care provider if the client reported taking which medication at home? Select all that apply. A) phenytoin B) warfarin C) acetaminophen D) ampicillin E) theophylline

Ans: A, B, E

Feedback: Use zafirlukast with caution if warfarin, theophylline, phenytoin, or aspirin are taken at the same time because increased toxicity can occur. Toxicity may also occur if these drugs are combined with calcium channel blockers, cyclosporine, or aspirin. No reported change of toxicity occurs when the client is currently taking acetaminophen or ampicillin.

Format: Multiple Selection Chapter: 55

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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2, 5 Page and Header: 996, Drugs Affecting Inflammation: Inhaled Steroids: Prototype Summary: Budesonide 31. A client diagnosed with asthma is going to begin taking an inhaled steroid. The nurse teaches the client that what adverse effects may occur when using this drug? Select all that apply. A) headache B) rebound congestion C) sepsis D) irritability E) depression

Ans: A, B, D

Feedback: Adverse effects associated with the use of inhaled steroids include irritability, headache, rebound congestion, and local infection, not sepsis or depression.

Format: Multiple Selection Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 989, Bronchodilators: Sympathomimetics: Contraindications and Cautions 32. The nurse knows the use of a sympathomimetic would be contraindicated or only used with great caution in clients with what disorder? Select all that apply.

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A) hypothyroidism B) cardiac disease C) kidney disease D) diabetes mellitus E) peripheral vascular disease

Ans: B, D, E

Feedback: Before administering a sympathomimetic, the nurse should assess for possible contraindications or cautions that include any known allergies to any drug in this class, cigarette use, cardiac disease, vascular disease, arrhythmias, diabetes, and hyperthyroidism. Sympathomimetics have no known adverse effects in hypothyroidism or kidney disease.

Format: Multiple Selection Chapter: 55 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Page and Header: 989, Bronchodilators: Sympathomimetics: Contraindications and Cautions 33. A 74-year-old client who has been diagnosed with progressive chronic obstructive pulmonary disease (COPD) is being managed on a variety of medications. What nonmedication intervention should the nurse consider for inclusion into the client’s plan of care? Select all that apply. A) Regularly scheduled rest periods 2-3 times a day. B) Use of a humidifier to add moisture to the room air. C) Schedule physical therapy sessions to help improve exercise tolerance. D) Schedule anxiety management training. E) Educate the client regarding low-sodium diet.

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Ans: A, B, C, D, E Feedback: Older adult clients diagnosed with progressive COPD may be taking many combined drugs to help them maintain effective respirations. These clients should have an overall treatment plan involving complex pulmonary hygiene, positioning, fluids, nutrition, humidified air, rest, and activity plans, as well as a complicated drug regimen to deal with the impact of this disease. Each of the options address at least one of these areas that affects the stress placed on the heart and lungs by this disease process.

Test Generator Questions, Chapter 56, Introduction to the Gastrointestinal System Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 1008, Structure and Function of the Gastrointestinal System: Structures 1. The nurse is educating a client about the peritoneum. What will the nurse state is the purpose of the peritoneum? A) Help propel the gastrointestinal contents down the tract. B) To keep the gastrointestinal tract in place and prevent friction with movement. C) Decrease the muscle tone to slow the gastrointestinal tract from moving too fast. D) Serve as a supportive layer and helps the tube maintain its shape.

Ans: B

Feedback: The peritoneum lines the abdominal wall and viscera and helps keep the gastrointestinal (GI) tract in place and prevents a buildup of friction with movement. The

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muscularis mucosa layer helps propel the GI contents downward. The nerve plexus helps to slow the GI tract when digestion is not a priority or stimulates it for digestion. The adventitia serves as a supportive layer and helps the tube maintain its shape.

Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 1011, Structure and Function of the Gastrointestinal System: Key Points 2. The nurse administers a medication that stimulates the parasympathetic nervous system to a client. The nurse will inform the client that the drug will have what impact on the gastrointestinal system? A) decreased sphincter tone B) decreased muscle tone C) decreased contractions D) decreased secretions

Ans: A

Feedback: The effect of the parasympathetic nervous system is that of “rest and digest.” It stimulates the nerve plexus that in turn stimulates the gastrointestinal (GI) tract causing increased muscle tone, secretions and contractions, and decreased sphincter tone allowing for easy movement.

Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation

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Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 1011, Gastrointestinal Reflexes: Local Reflexes 3. The nurse is preparing education for a group of adult clients. What reflex will the nurse indicate causes an increase in small intestine activity when the stomach is stimulated by stretching, the presence of food, or cephalic stimulation? A) duodenal–colic B) gastroenteric C) gastrocolic D) ileogastric

Ans: B

Feedback: The gastroenteric reflex is stimulation of the stomach, which causes an increase in activity in the small intestine. The duodenal–colic reflex stimulates colon activity and mass movement. The gastrocolic reflex is stimulation in the stomach, which increases activity in the colon. The ileogastric reflex is the introduction of chyme or stretch to the large intestine and slow stomach activity.

Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 1009, Structure and Function of the Gastrointestinal System: Enteric Nervous System 4. The nurse expects to find that the major activities of the gastrointestinal (GI) tract decrease in a client experiencing what?

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A) a stress reaction B) a medication regimen including cholinergic drugs C) a local irritation of the small intestine D) thoughts of food Ans: A

Feedback: Stimulation of the sympathetic nervous system will decrease all activity in the GI tract, and stress is a trigger for stimulating the sympathetic nervous system. Parasympathetic stimulation caused by cholinergic drugs, local irritation of the intestine, and the thought of food will all increase GI activity.

Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 1011, Gastrointestinal Reflexes: Local Reflexes 5. The nurse assesses the client who had abdominal surgery and finds a complete absence of bowel sounds. The nurse knows this is caused by what reflex? A) gastrocolic reflex B) renointestinal reflex C) intestinal–intestinal reflex D) somatointestinal reflex

Ans: C

Feedback: After the intestinal irritation that occurs with handling the bowel during abdominal surgery, the risk of paralytic ileus is high because of the intestinal–intestinal reflex. The gastrocolic reflex increases gastrointestinal (GI) movement when food is in the stomach. The renointestinal reflex slows GI activity in response to renal capsule

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swelling. The somatointestinal reflex slows GI activity in response to tight stretching of skin across the abdominal wall.

Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 1012, Gastrointestinal Reflexes: Central Reflexes: Swallowing 6. The nurse is caring for a client having difficulty swallowing tablets. What action will the nurse implement to help the client swallow medication? A) Turn the client’s head to one side. B) Place a warm cloth on the back of the client’s neck. C) Have the client suck on a popsicle. D) Give the client a copious amount of water to drink with the tablet.

Ans: C

Feedback: Have the client suck on a popsicle, which will block external nerve impulses and allow the basic reflex to respond. The client’s head should be straight to allow the muscle pairs to work together. A cold cloth can be placed on the back of the neck or the sternum to stimulate the reflex, but a warm cloth is not indicated. Textured food, not liquids, can also help with swallowing a tablet.

Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process

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Objective: 5 Page and Header: 1012, Gastrointestinal Reflexes: Central Reflexes: Vomiting 7. What does the nurse anticipate will happen first when the chemoreceptor trigger zone (CTZ) of a client is stimulated? A) salivation increases B) gastric acid production increases C) sweating increases D) heart rate increases

Ans: A

Feedback: When the CTZ is stimulated, salivation is stimulated first, which leads to a decrease in gastric acid production and then an increase in sweating and heart rate.

Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 1011, Structure and Function of the Gastrointestinal System: Gastrointestinal Activities: Motility 8. The nurse is educating a group of adult clients. What will the nurse indicate is the basic type of movement that occurs in the esophagus? A) peristalsis B) mass movement C) churning D) segmentation

Ans: A

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Feedback: Peristalsis is the basic movement of the esophagus. The large intestine uses mass movement, the stomach uses churning, and the small intestine uses segmentation.

Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 1008, Structure and Function of the Gastrointestinal System: Structures 9. The nurse is caring for a client who is about to undergo gastric bypass surgery. The nurse will explain the majority of nutrients are absorbed where? A) sigmoid colon B) stomach C) small intestine D) ascending colon

Ans: C

Feedback: The stomach empties into the small intestine where absorption of nutrients occurs. Therefore, very little absorption occurs in the stomach, mostly limited to alcohol and water. The colon allows for water to be absorbed from the feces but does not absorb nutrients.

Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy

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Integrated Process: Nursing Process Objective: 1 Page and Header: 1011, Structure and Function of the Gastrointestinal System: Gastrointestinal Activities: Absorption 10. When providing education to a client, the nurse will indicate water is primarily absorbed in which portion of the gastrointestinal tract? A) duodenum B) jejunum C) ileum D) colon

Ans: D

Feedback: The colon absorbs water and sodium. The duodenum, ileum, and jejunum are parts of the small intestine where nutrients are absorbed.

Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 1010, Gastrointestinal Reflexes: Secretion 11. The nurse is caring for a client who does not produce adequate mucus in the stomach. This places the client at risk for what health complication? A) gastroesophageal reflux B) peptic ulcers C) constipation D) vomiting

Ans: B

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Feedback: Mucous functions to protect the lining of the digestive tract from digestive juices and protects the gastrointestinal mucosa from injury. Lack of mucous does not cause reflux, constipation, or vomiting.

Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 1011, Gastrointestinal Reflexes: Local Reflexes 12. A client is experiencing the duodenal–colic reflex. The nurse should recognize what likely stimulus? A) Stool is in the client’s large bowel. B) Food is present in the small intestine. C) The client is currently eating. D) The client has begun swallowing.

Ans: B

Feedback: The duodenal–colic reflex is stimulated by the presence of food or stretching in the duodenum that stimulates colon activity and mass movement, again to empty the colon for the new chyme. It is not stimulated by stool in the large bowel, eating, or swallowing.

Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply

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Difficulty: Difficult Integrated Process: Nursing Process Objective: 1 Page and Header: 1008, Structure and Function of the Gastrointestinal System: Structures 13. The nurse is caring for a client who has sustained damage to the omenta. What complication should the nurse assess for when caring for this client? A) imbalanced nutrition B) nausea C) infection D) aspiration

Ans: C

Feedback: The greater and lesser omenta hang from the stomach over the lower gastrointestinal (GI) tract and are full of lymph nodes, lymphocytes, monocytes, and other components of the immune and inflammatory systems. This barrier provides rapid protection for the rest of the body if any of the bacteria or other foreign agents in the GI tract should be absorbed into the body. Because of this immune and inflammatory role, damage to the omenta could increase the client’s risk for infection. It would not have a direct bearing on nutritional status or the ability to swallow and risk of aspiration. The omenta does not participate in the physiology of nausea or vomiting.

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14. The nurse is caring for a pediatric client who has been diagnosed with cystic fibrosis and whose body does not produce pancreatic enzymes appropriately. When planning the client’s care, the nurse should address which concern? A) inadequate secretion of insulin B) unstable serum glucose levels C) incomplete digestion of carbohydrates D) fluid imbalances

Ans: C

Feedback: The absence of the pancreatic enzymes results in inadequate digestion and absorption of carbohydrates, fats, and proteins. The pancreas also secretes insulin and glucagon, hormones that regulate glucose metabolism and regulate blood sugar levels, but this is not related to enzymes but rather to hormone secretion. Fluid balance is not maintained by pancreatic enzymes.

Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 1008, Structure and Function of the Gastrointestinal System: Structures 15. The nurse is caring for a client who has been diagnosed with liver disease. What does the nurse indicate the liver produces that is important in the digestive process? A) bile B) glucagon C) ammonia D) bilirubin

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Ans: A

Feedback: The liver produces bile, which is stored in the gallbladder. The bile is very important in the digestion of fats and is deposited into the small intestine when the gallbladder is stimulated to contract by the presence of fats. Glucagon is a hormone secreted by the pancreas in response to the presence of food in the bowel. Ammonia is a byproduct of the breakdown of protein, and bilirubin is metabolized by the liver and stored to produce more red blood cells.

Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 1011, Gastrointestinal Reflexes: Local Reflexes 16. The client is experiencing the effects of the gastroenteric reflex after eating a meal. The nurse can assess the effects of this reflex by what intervention? A) inspecting the consistency of the client’s stool B) monitoring the client for the onset of vomiting C) assessing the client’s level of nausea D) auscultating the client’s bowel sounds Ans: D

Feedback: Stimulation of the stomach by stretching, the presence of food, or cephalic stimulation (the body’s response to smelling, seeing, tasting, or thinking about food) causes an increase in activity in the small intestine. This is a result of the gastroenteric reflex and can be identified by auscultation. It is not associated with nausea, vomiting, or changes in the character of stool.

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Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 1012, Gastrointestinal Reflexes: Central Reflexes: Swallowing 17. The nurse recognizes a client with damage to what area of the brain will likely have an altered ability to swallow? A) temporal lobe B) medulla oblongata C) cerebellum D) pons

Ans: B

Feedback: Swallowing is a voluntary act that is regulated by a swallowing center in the medulla oblongata of the central nervous system. Swallowing is not mediated by the temporal lobe, cerebellum, or pons.

Format: Multiple Selection Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Difficult Integrated Process: Nursing Process Objective: 1 Page and Header: 1010, Gastrointestinal Reflexes: Secretion 18. The nurse is caring for a client who has been diagnosed with a suspected malabsorption disorder as the result of pancreatic damage. The client may require supplements of what digestive enzymes? Select all that apply.

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A) pepsin B) lipase C) amylase D) trypsin E) secretin

Ans: B, C, D

Feedback: Digestive enzymes secreted by the pancreas include trypsin, which aids in digesting protein; amylase, which aids in digesting starch; and lipase, which aids in digesting fats. Pepsin and secretin are secreted by the stomach.

Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 1011, Structure and Function of the Gastrointestinal System: Gastrointestinal Activities: Motility 19. The nurse obtain a history from a client who admits ignoring the need to defecate when busy. The nurse should explain what unintended consequence of this behavior could occur to the client? A) The client’s external sphincter will require more distention to stimulate a defecation reflex. B) The client risks becoming incontinent of stool due to the loss of sphincter control. C) Stool will become saturated with water as it sits in the colon, resulting in diarrhea. D) Absorption of nutrients from the large bowel will be impaired because the stool will harden.

Ans: A

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Feedback: The receptors in the external sphincter adapt relatively quickly and will stretch and require more and more distention to stimulate the reflex if the reflex is ignored. This will not lead to bowel incontinence and is more likely to result in constipation from prolonged water absorption than diarrhea. Nutrients are not absorbed from the colon.

Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 1011, Structure and Function of the Gastrointestinal System: Absorption 20. The nurse informs a client that nutrients absorbed from the small intestine travel directly to the liver by what system? A) mesenteric B) splenic C) arterial D) portal

Ans: D

Feedback: The portal system drains the entire lower gastrointestinal tract, where absorption occurs, and delivers what is absorbed into the venous system directly to the liver. This does not occur by way of the mesenteric system, splenic system, or arterial system.

Format: Multiple Choice

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Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 1011, Gastrointestinal Reflexes: Local Reflexes 21. The nurse is caring for a client who has developed severe constipation. The nurse observes the client’s food intake for the past 24 hours has been minimal as a result of which reflex? A) ileogastric B) intestinal–intestinal C) peritoneointestinal D) renointestinal

Ans: A

Feedback: The introduction of chyme or stretch to the large intestine slows stomach activity, known as the ileogastric reflex, which explains why clients who are constipated have no appetite. The intestinal–intestinal reflex is triggered by irritation of a section of the small intestine causing cessation of activity above that section. Peritoneointestinal reflex results from irritation of the peritoneum, while renointestinal reflex results from irritation or swelling of the renal capsule.

Format: Multiple Selection Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 1008, Structure and Function of the Gastrointestinal System

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22. The nurse is educating a client on digestion. What organs will the nurse indicate are considered accessory digestive organs which aid in the digestive process? Select all that apply. A) liver B) pancreas C) spleen D) gallbladder E) appendix

Ans: A, B, D

Feedback: The pancreas, liver, and gallbladder are accessory organs that support the functions of the GI system. The spleen is not involved in digestion, and the appendix is a part of the bowel, not an accessory organ.

Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 1012, Gastrointestinal Reflexes: Central Reflexes: Swallowing 23. The nurse is caring for a client who has had a stroke resulting in mild dysphagia. In order to promote safe and effective swallowing, the nurse should perform what action? A) Position the client in a semi-Fowler’s position with the head slightly to the side. B) Distract the client during swallowing to allow basic reflexes to respond. C) Have the client gargle and spit water before attempting to swallow. D) Apply a cold compress to the back of the client’s neck.

Ans: D

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Feedback: Icing the sternal notch or the back of the neck has proved effective in stimulating the swallowing reflex. In addition, keeping the head straight (not turned to one side) allows the muscle pairs to work together and helps the process. The client should be fully upright. Gargling and spitting are of no noted benefit. Similarly, distracting the client does not facilitate swallowing.

Format: Drag and Drop Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 1012, Gastrointestinal Reflexes: Central Reflexes: Swallowing 24. The nurse is educating a group of adult clients about the swallowing reflex. Place the following steps of the swallowing reflex in the order in which they occur. Use each option once. A) Larynx rises and the glottis closes. B) Soft palate elevates. C) Pharyngeal constrictor muscles contract. D) The bolus moves down the esophagus. E) Respirations cease.

Ans: B, E, A, C, D

Feedback: Receptors send impulses to the medulla, which stimulates a series of nerves that cause the following actions, which are the soft palate elevates and seals off the nasal cavity, respirations cease in order to protect the lungs, the larynx rises and the glottis closes to seal off the airway, and the pharyngeal constrictor muscles contract and force the food bolus into the top of the esophagus, where pairs of muscles contract in turn to move the bolus down the esophagus into the stomach.

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Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 1012, Gastrointestinal Reflexes: Central Reflexes: Vomiting 25. The chemoreceptor trigger zone (CTZ) in a client’s medulla has been stimulated. The nurse explains to the client that what will most likely occur following repeated stimulation? A) repeated swallowing B) decreased respiratory rate C) vomiting D) increased peristalsis

Ans: C

Feedback: Stimulation of the CTZ in the medulla causes vomiting. The client may start swallowing repeatedly, but this is simply a precursor to vomiting. CTZ stimulation does not increase peristalsis or lower the client’s respiratory rate.

Format: Multiple Selection Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 1012, Gastrointestinal Reflexes: Central Reflexes: Vomiting

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26. The nurse recognizes the potential for stimulation of the client’s chemoreceptor trigger zone (CTZ) in what circumstance? Select all that apply. A) stimulation of the back of the throat when examining the oral cavity B) excessive stomach distention C) increased intracranial pressure D) stimulation of stretch receptors in the large bowel E) when the client sits up abruptly

Ans: A, B, C

Feedback: Tactile stimulation of the back of the throat, excessive stomach distention, increased intracranial pressure, stimulation of vestibular receptors in the inner ear, and stimulation of stretch receptors in the uterus and bladder are types of stimuli that can activate the CTZ. Stimulating stretch receptors in the large bowel and sitting up abruptly are not activators of the CTZ.

Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 1012, Gastrointestinal Reflexes: Central Reflexes: Vomiting 27. The client who experiences nausea produces less stomach acid. The nurse recognizes this as having what effect? A) increases the feeling of nausea B) protects the lining of the upper gastrointestinal tract C) stimulates the parasympathetic nervous system D) directs fluid to mucous production in the small bowel

Ans: B

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Feedback: There is a large increase in the production of mucus in the upper gastrointestinal (GI) tract, which is accompanied by a decrease in gastric acid production. This action protects the lining of the GI tract from potential damage by the acidic stomach contents when vomiting occurs. It does not increase the feeling of nausea, stimulate the parasympathetic nervous system, nor does it direct fluid to mucous production.

Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 1012, Gastrointestinal Reflexes: Central Reflexes: Vomiting 28. The nurse is caring for a pediatric client with a decreased level of consciousness after a bicycle accident. The client begins to have projectile vomiting. How should the nurse best interpret this behavior? A) The client may be in intense pain. B) The client may have eaten heavily before the accident. C) The client likely has a full bladder and is unable to void. D) The client’s intracranial pressure may be elevated.

Ans: D

Feedback: Increased intracranial pressure (ICP) applies direct pressure to the CTZ resulting in projectile vomiting. This client requires a thorough neurological assessment. Intense pain would be indicated by crying. A full bladder or overeating would not cause projectile vomiting in a healthy pediatric client.

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Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 1012, Gastrointestinal Reflexes: Central Reflexes: Vomiting 29. The nurse is caring for a client who has recently vomited. What physiologic change will have protected the client’s lungs when vomiting? A) closing of the glottis B) deep respirations C) production of extra saliva in the mouth D) temporary reduction in acid production in the stomach

Ans: A

Feedback: The glottis must close and seal off the trachea in order to prevent entry of stomach contents into the lungs. The client normally takes a deep breath just before the glottis closes but should not breath during emesis. Production of extra saliva and reduction in stomach acid do not protect the lungs.

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A) Offer the client a drink. B) Put the client in a supine position. C) Ready the emesis basin. D) Continue the bath.

Ans: C

Feedback: Nauseated clients who start swallowing repeatedly report secretions in their throat are in the process of preparing for vomiting. The nurse should reach for the emesis basin. Offering water will increase vomiting. Placing the client in a supine position risks the danger of aspiration of stomach contents into the lungs. Continuing the bath does not prepare the nurse if the client begins to vomit.

Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 1011, Gastrointestinal Reflexes: Local Reflexes 31. The nurse’s assessment of a client suggests chronic constipation may be the result of overactivity of the somatointestinal reflex. What assessment question should the nurse ask the client? A) “How many calories do you eat per day?” B) “Do you often wear constraining clothing?” C) “Do you often ignore the need to urinate, allowing your bladder to fill?” D) “Do you take nonsteroidal antiinflammatories on a regular basis?”

Ans: B

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Feedback: The nurse would assess the client to determine whether tight constraining clothing is worn because taut stretching of skin and muscles over the abdomen irritates the nerve plexus and causes a slowing or cessation of GI activity to prevent further irritation. This constitutes overactivity of the somatointestinal reflex. Increased or decreased calorie intake would not contribute to constipation unless it were accompanied by low fiber and/or inadequate fluid intake. It is unlikely the urge to void could be ignored long enough to cause constipation. NSAIDs do not normally cause constipation.

Format: Multiple Choice Chapter: 56 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 1012, Gastrointestinal Reflexes: Central Reflexes: Vomiting 32. The school nurse will prioritize monitoring which school age client for vomiting? A) a 5-year-old client who rides the playground’s twirl-a-whirl ride after lunch B) a 9-year-old client who is back in school after completing chemotherapy C) a 12-year-old client who fell and sustained an abrasion on the knee D) a 14-year-old client who is worried about an upcoming test

Ans: A

Feedback: Stimulation of the vestibular receptors in the inner ear (a reaction often seen with dizziness after “wild” rides in amusement parks) is a primary trigger for vomiting. Intense pain and fear/worry may stimulate vomiting, but it likely only when intense pain or the fight-or-flight situation exists. While chemotherapy can trigger vomiting, it is more likely to occur during or right after a series of treatments.

Format: Multiple Choice Chapter: 56

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Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 1011, Gastrointestinal Reflexes: Local Reflexes 33. Which client should the nurse monitor closely for an extreme reaction to a dysfunction triggered by intestinal–intestinal reflex? A) a client following surgical removal of the gallbladder B) a client diagnosed with traveler’s diarrhea C) a client reporting chronic constipation D) a client reporting low abdominal pain and urinary urgency

Ans: A

Feedback: Intestinal–intestinal reflex involves excessive irritation to one section of the small intestine causing a cessation of activity above that section to prevent further irritation and an increase in activity below that section, which leads to a flushing of the irritant. An extreme reaction to this reflex can be seen after abdominal surgery, when the handling of the intestines causes intense irritation and the reflex can cause the entire intestinal system to cease activity, leading to a paralytic ileus. While intestinal–intestinal reflex is active in traveler’s diarrhea (a local irritation of the intestine causing increased secretions and movement below that section, in this case resulting in watery diarrhea and a cessation of movement above that section), it is not an extreme reaction. Ileogastric reflex involves the introduction of chyme or stretch to the large intestine slowing stomach activity, as does the introduction of chyme into the small and large intestine, allowing time for absorption. In part, this reflex explains why clients who are constipated often have no appetite: the continued stretch on the ileum that comes with constipation continues to slow stomach activity and makes the introduction of new food into the stomach undesirable. Vesicointestinal reflex is associated with irritation or overstretching of the bladder that can cause a reflex cessation of movement in the GI tract, again preventing further irritation to the bladder from GI movement. Many clients

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with cystitis, an inflammation of the bladder, usually caused by a bladder infection report constipation, which can be attributable to this reflex.

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