Errors: Preventing Responding

Multiple Choice

1. Which situation is an example of a medication error?

a. A patient refuses her morning medications.

b. A patient receives a double dose of a medication because the nurse did not cut the pill in half.

c. A patient develops hives after starting an intravenous antibiotic 24 hours earlier.

d. A patient reports severe pain still present 60 minutes after a pain medication was given.

ANS: B

A medication error is defined as a preventable adverse drug event that involves inappropriate medication use by a patient or health care provider. Refusing morning medications and reporting severe pain after having been given medication are examples of patient behaviours. The development of hives is a possible allergic reaction. None of these situations is preventable.

DIF: Cognitive Level: Application REF: p. 94 a. digoxin .125 mg b. digoxin .1250 mg c. digoxin 0.125 mg d. digoxin 0.1250 mg

2. Which is the proper notation for the dose of the drug ordered?

ANS: C

Always use a leading zero for decimal dosages (e.g., digoxin 0.125 mg) with medication orders or their transcription. Omitting the leading zero may cause the order to be misread, resulting in a large drug overdose. Never use trailing zeros.

DIF: Cognitive Level: Application REF: p. 96 a. ―It‘s listed here on the medication sheet, so you should take it.‖ b. ―Go ahead and take it, and then I‘ll check with your doctor about it.‖ c. ―It wouldn‘t be listed here if it wasn‘t ordered for you!‖ d. ―I‘ll check on the order first, before you take it.‖

3. When the nurse is giving a scheduled morning medication, the patient states, ―I haven‘t seen that pill before. Are you sure it‘s correct?‖ The nurse checks the medication administration record and sees that medication is listed. Which is the nurse‘s best response to the patient?

ANS: D

When giving medications, the nurse must always listen to and honour any concerns or doubts expressed by the patient. If the patient doubts an order, the nurse should check the written order, check with the prescriber, or both. The other options included with this example illustrate the nurse‘s not listening to the patient‘s concerns.

DIF: Cognitive Level: Application REF: p. 96

4. The physician has written admission orders, and the nurse is transcribing them. The nurse is having difficulty transcribing one order because of the physician‘s handwriting. The best action for the nurse to take is to a. ask a colleague what the order says. b. contact the physician in order to clarify the order. c. contact the pharmacy in order to clarify the order. d. ask the patient what medications are being taken at home.

ANS: B

If a prescriber writes an order that is illegible, the nurse should contact the prescriber for clarification. The nurse should not ask a colleague what the order says because the colleague did not write the order. The nurse should not contact the pharmacy to clarify the order because this action would delay implementation of the order. Asking the patient what medications are taken at home is incorrect because this question will not clarify the current order.

DIF: Cognitive Level: Comprehension REF: p. 96 a. Institute for Safe Medications Practices (ISMP) Canada b. Accreditation Canada c. Canadian Patient Safety Institute (CPSI) d. Health Canada

5. Health care providers should report actual and potential medication errors to which organization?

ANS: A

Actual and potential medication errors should be reported to ISMP Canada; confidentiality of the reporter is respected. AccNreU dR itaS tiI onNCGaTnaBd. a,CCO PM SI, and Health Canada all offer information pertaining to medication safety.

DIF: Cognitive Level: Knowledge REF: p. 99

Multiple Response

1. Which statements are true regarding an adverse drug reactions (ADRs)? (Select all that apply.)

a. Adverse effects are ADRs that are usually predictable.

b. ADRs always result in harm to patients.

c. All ADRs are preventable if proper precautions are taken.

d. ADRs can be unexpected and unintended responses to medications.

ANS: A, D

An ADR is defined as any unexpected, undesired, or excessive response to a medication. Adverse effects are ADRs that are usually not severe enough to warrant stopping the medication. Not all ADRs result in harm to the patient. Some ADRs, such as allergic or idiosyncratic reactions, may not be preventable or predicted.

DIF: Cognitive Level: Knowledge REF: p. 91

Chapter 07: Patient Education and Drug Therapy

Lilley: Pharmacology for Canadian Health Care Practice, 3rd Canadian Edition

Multiple Choice

1. Which diagnosis is appropriate for the patient who has just received a prescription for a new medication?

a. Nonadherence related to a new drug therapy b. High risk for nonadherence related to new drug therapy c. Knowledge deficit related to newly prescribed drug therapy d. Deficient knowledge related to newly prescribed drug therapy

ANS: D

The patient who has a limited understanding of newly prescribed drug therapy may have the nursing diagnosis of deficient knowledge. ―Nonadherence‖ implies that the patient does not follow a recommended regimen, which is not the case with a newly prescribed drug. ―High risk for nonadherence related to new drug therapy‖ is not a North American Nursing Diagnosis Association nursing diagnosis, and ―Deficient knowledge related to newly prescribed drug therapy‖ is an outdated nursing diagnosis.

DIF: Cognitive Level: Analysis REF: p. 109 a. The patient will know about insulin injections. b. The patient will understand the principles of insulin preparation. c. The patient will demonstrate the proper technique of mixing insulin. d. The patient will comprehenU d thS e pN ropeT r technO ique of preparing insulin.

2. Which statement reflects a measurable goal?

ANS: C

The word ―demonstrate‖ is a measurable verb, and measurable terms should be used when developing goals and outcome criteria statements. The terms ―know,‖ ―understand‖ and ―comprehend‖ are not measurable terms.

DIF: Cognitive Level: Analysis REF: p. 109 a. ―Are you allergic to penicillin?‖ b. ―What medications do you take?‖ c. ―Have you had a reaction to this drug?‖ d. ―Are you taking this medication with meals?‖

3. During an assessment, which question allows the nurse to clarify and open up discussion with the patient?

ANS: B

―What medications do you take?‖ is an open-ended question that will encourage more clarification and discussion from the patient. ―Are you allergic to penicillin?‖ is a closed-ended question, as are ―Have you had a reaction to this drug?‖ and ―Are you taking this medication with meals?‖ Closed-ended questions prompt only a ―yes‖ or ―no‖ answer and provide limited information.

DIF: Cognitive Level: Application REF: pp. 108-109 a. Showing a colourful video about anticoagulation therapy b. Presenting all the information in one session just before discharge c. Giving the patient pamphlets about the medications to read at home d. Developing large-print handouts that reflect the verbal information presented

4. The nurse is setting up a teaching–learning session with an 85-year-old patient who will be going home on anticoagulant therapy. Which strategy will reflect consideration of aging changes that may occur?

ANS: D

Developing large-print handouts that reflect the verbal information presented will address altered perception in two ways. First, using visual aids reinforces the verbal instructions by addressing the patient‘s possibly decreased ability to hear high-frequency sounds. Second, developing the handouts in large print addresses the possibility of decreased visual acuity. Showing a colourful video about anticoagulation therapy does not allow for discussion of the information; furthermore, the text and print may be small and difficult to read and understand. Presenting all the information in one session just before discharge also does not allow for discussion, and the patient may not be able to hear or see the information sufficiently. Because of the possibility of decreased short-term memory and slowed cognitive function, giving the patient pamphlets about the medications to read at home is not appropriate.

DIF: Cognitive Level: Application REF: p. 111

5. When the nurse is teaching a manual skill, such as self-injection of insulin, the best way to set up the teaching-learning session is to a. provide written pamphlets for instruction. b. show a video and allow the patients to practice as needed on their own. c. verbally explain the procedUureSandNproTvide wrOitten handouts for reinforcement. d. allow the patients to do several ―return‖ demonstrations after the nurse has demonstrated the procedure.

ANS: D

Return demonstrations allow the nurse to evaluate the patient‘s newly learned skills. Providing written pamphlets for instruction, showing a video and then allowing patients to practice as needed on their own, and verbally explaining the procedure and providing written handouts for reinforcement do not allow for evaluation of the patient‘s technique.

DIF: Cognitive Level: Analysis REF: p. 112 a. Physical b. Affective c. Cognitive d. Psychomotor

6. A patient and the dietitian have just reviewed the patient‘s new diet, which is low protein and low potassium. This reviewing constitutes learning in which domain?

ANS: C

The cognitive domain refers to problem-solving abilities and may involve recall and knowledge of facts. The physical domain is not one of the learning domains. The affective domain refers to values and beliefs. The psychomotor domain may involve actions such as learning how to perform a procedure.

DIF: Cognitive Level: Comprehension REF: p. 106 a. Trust versus mistrust b. Intimacy versus isolation c. Industry versus inferiority d. Identity versus role confusion

7. The nurse needs to teach a 16-year-old patient, newly diagnosed with diabetes, about blood glucose monitoring and the importance of regulating glucose intake. When the nurse is developing the teaching plan, which of Erickson‘s stages of development should be considered?

ANS: D

According to Erickson, the adolescent, 12 to 18 years of age, is in the ―identity versus role confusion‖ stage of development. According to Erikson, ―trust versus mistrust‖ reflects the infancy stage; ―intimacy versus isolation‖ reflects the young adulthood stage; and ―industry versus inferiority‖ reflects the school-age stage of development.

DIF: Cognitive Level: Comprehension REF: p. 108, Box 7-3 a. Teach effective coping strategies. b. Reduce the number of drugs prescribed. c. Assure the patient that she won‘t forget once she is accustomed to the routine. d. Help the patient obtain anNd leRarnIto uGse a Bc . aC lendMar or a pill container.

8. A 60-year-old patient is on several new medications and expresses worry that she will forget to take her pills. For a patient in this situation, the most helpful response from the nurse is to do what?

ANS: D U S N T O

Calendars, pill containers, or diaries may be helpful to patients who may forget to take prescribed drugs as scheduled. The nurse must ensure that the patient knows how to use these reminder tools. Teaching the patient effective coping strategies is a helpful suggestion but will not help the patient to remember to take medications. Reducing the number of drugs prescribed is not an appropriate action by the nurse. Assuring the patient that she won‘t forget once she is accustomed to the routine is false reassurance by the nurse and inappropriate when education is needed.

DIF: Cognitive Level: Application REF: p. 110

Multiple Response

1. Which are appropriate considerations when the nurse is assessing the learning needs of a patient? (Select all that apply.)

a. Cultural background b. Social support c. Level of education d. Readiness to learn e. Health beliefs

ANS: A, B, C, D, E

All options are appropriate to consider when the nurse is assessing learning needs.

DIF: Cognitive Level: Comprehension REF: pp. 106-108

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Chapter 08: Over-the-Counter Drugs and Natural Health Products

Lilley: Pharmacology for Canadian Health Care Practice, 3rd Canadian Edition

Multiple Choice

1. A 25-year-old woman is visiting the prenatal clinic and shares with the nurse her desire to go ―natural‖ with her pregnancy. She shows the nurse a list of natural health products that she wishes to take so she can ―avoid taking any drugs.‖ Which statement represents the nurse‘s best response?

a. Most natural health products are nontoxic and safe for use during pregnancy.

b. Please read the labels carefully before use, to check for cautionary warnings.

c. Products from different manufacturers are required to contain consistent amounts of herbal constituents.

d. Natural health products are actually drugs of unproven safety and should not be taken during pregnancy without medical supervision.

ANS: D

Natural health products are actually drugs of mostly unproven safety, especially for pregnant women; many have not been tested for safety during pregnancy. Manufacturers are not required to provide cautionary statements or guarantee the reliability of the contents. The labels on natural health products may not provide enough information for use during pregnancy. Manufacturers of natural health products are not required to guarantee the reliability of the contents.

DIF: Cognitive Level: Analysis REF: p. 126| p. 128

2. The role of the Natural Healt N h UPr R oS du I ctN s G DTire B c . to C raOte M (NPHD) is to see that a. natural health products are regulated for safety and quality. b. natural health products are held to the same standards as drugs. c. producers of natural health products prove the therapeutic efficacy of their products. d. natural health products are protected by patent laws.

ANS: A

The NPHD ensures access to safe, effective, and quality natural health products.

DIF: Cognitive Level: Analysis REF: pp. 121-122 a. Cancer risk b. Liver toxicity c. Cardiovascular incidents d. Intestinal disorders

3. Which is a concern regarding the use of the natural health product kava?

ANS: B

The herb kava is found in herbal and homeopathic preparations and sometimes in food. Kava is promoted for the treatment of anxiety, nervousness, insomnia, pain, and muscle tension. Health Canada has issued warnings about possible liver toxicity with the use of kava root. In 2012, after a 10-year ban, Health Canada regulated kava root as a new drug.

DIF: Cognitive Level: Knowledge REF: p. 122 a. digoxin b. All caffeine-containing products c. Alcoholic beverages d. Selective serotonin reuptake inhibitors

4. A patient tells the nurse that she wants to begin taking St. John‘s wort for treatment of depression. The nurse should warn her about which substance that may cause an interaction with St. John‘s wort?

ANS: D

Drug interactions may occur with the ingestion of other serotonergic drugs, such as selective serotonin reuptake inhibitors; the drug interaction may lead to serotonin syndrome.

DIF: Cognitive Level: Comprehension REF: p. 123 a. acetaminophen b. warfarin c. digoxin d. phenytoin

5. A patient says that he eats large amounts of garlic for its cardiovascular benefits. Which drug, if taken, could have a potential interaction with the garlic?

ANS: B

When taking garlic, taking any drugs that may interfere with platelet and clotting functions should be avoided. These drugs include antiplatelet drugs, anticoagulants (e.g., warfarin), nonsteroidal anti-inflammatory drugs (NSAIDs), and acetylsalicylic acid (Aspirin).

Acetaminophen, digoxin, andNpUhRenS yI toN inGdT o Bno. t ChaOvM e interactions with garlic.

DIF: Cognitive Level: Analysis REF: p. 123

6. When teaching patients about over-the-counter (OTC) and natural health products, the nurse should teach the patients that a. histamine-blocking agents should be taken with antacids to prevent gastrointestinal upset. b. drug interactions are rare with OTC products because OTC drugs are safer than prescription drugs. c. manufacturers of natural health products are required to provide evidence of safety and effectiveness; therefore, check the labels carefully. d. natural health products and OTC drugs cannot be safely administered to infants, children, and pregnant or lactating women without first checking with the health care provider.

ANS: D

Natural health products and OTC drugs are not necessarily safe for infants, children, and pregnant or lactating women; the health care provider should be contacted before use.

―Histamine-blocking agents should be taken with antacids to prevent gastrointestinal upset,‖

―Drug interactions are rare with OTC products because OTC drugs are safer than prescription drugs,‖ and ―Manufacturers of natural health products are required to provide evidence of safety and effectiveness; therefore, check the labels carefully‖ are all false statements.

DIF: Cognitive Level: Comprehension REF: p. 126 a. Chinese b. Japanese c. Hispanic d. European

7. Patients from which culture will not report gastrointestinal symptoms caused by OTC drugs or natural health products?

ANS: B

Japanese patients experiencing nausea, vomiting, or bowel changes as a result of OTC drugs or natural health products often do not mention these symptoms. Because the Japanese culture considers complaining about gastrointestinal symptoms to be unacceptable, these symptoms may go unreported. The nurse needs to be aware of this implication for this ethnocultural group.

DIF: Cognitive Level: Comprehension REF: p. 125

Multiple Response

1. Which statement is true regarding the use of OTC drugs? (Select all that apply.)

a. Use of OTC drugs may delay treatment of more serious ailments.

b. Drug interactions with OTC medications are rare.

c. OTC drugs may relieve symptoms without addressing the cause of the problem.

d. OTC drugs are indicated for long-term treatment of conditions.

e. Patients may misunderstand product labels and misuse the drugs.

ANS: A, C, E

―Use of OTC drugs may delay treatment of more serious ailments,‖ ―OTC drugs may relieve symptoms without addressing the cause of the problem,‖ and ―Patients may misunderstand product labels and misuse the drugs‖ are all true statements about the use of OTC drugs and should be included when patients are being taught about their use. Drug interactions may indeed occur with prescription medications and other OTC drugs. Normally, OTC drugs are intended for short-term treatment of minor ailments.

DIF: Cognitive Level: Analysis REF: p. 118

Chapter 09: Vitamins and Minerals

Lilley: Pharmacology for Canadian Health Care Practice, 3rd Canadian Edition

Multiple Choice

1. Conditions such as infantile rickets, tetany, and osteomalacia are caused by a deficiency in which vitamin or mineral?

a. Vitamin D b. Vitamin K c. Magnesium d. Cyanocobalamin

ANS: A

Conditions such as infantile rickets, tetany, and osteomalacia are all results of long-term vitamin D deficiency.

DIF: Cognitive Level: Comprehension REF: p. 136 a. Risk for impaired skin integrity due to vitamin deficiency b. Disturbed sensory perception (visual) due to night blindness c. Impaired physical mobility (muscle weakness) due to vitamin deficiency d. Disturbed thought processes (confusion and psychosis) due to vitamin deficiency

2. Which nursing diagnosis is appropriate for the patient undergoing therapy with vitamin A?

ANS: B

Vitamin A deficiency causes night blindness.

N R I G B.C M

DIF: Cognitive Level: Analysis REF: p. 134 a. Urticaria b. Anorexia c. Diarrhea d. Tinnitus

3. Which symptom may indicate toxicity during vitamin D therapy?

ANS: B

Anorexia may indicate vitamin D toxicity.

DIF: Cognitive Level: Comprehension REF: p. 136, Table 9-4 a. Oral calcium supplements should be taken before meals. b. Calcium products bind with tetracyclines, making the antibiotic inactive. c. Foods high in calcium include whole grain cereals, egg yolks, and liver. d. Foods high in oxalate and zinc, such as spinach and legumes, increase the absorption of oral calcium supplementation.

4. Which dietary information is important for the patient taking calcium supplements?

ANS: B

Calcium products chelate or bind with tetracyclines, resulting in decreased effects of tetracyclines. Foods high in calcium include milk and other dairy products, shellfish, and dark green leafy vegetables. Oral calcium supplements should be taken with meals.

DIF: Cognitive Level: Analysis REF: p. 150 a. Ototoxicity b. Metabolic acidosis c. Nephrotoxicity d. Respiratory arrest

5. What adverse effect may occur from calcium salt infusion?

ANS: B

Adverse effects from calcium salts include metabolic acidosis, as well as hemorrhage, hypertension, constipation, obstruction, nausea, vomiting, flatulence, kidney dysfunction, and hypercalcemia.

DIF: Cognitive Level: Application REF: p. 147 a. Vitamin B3 b. Vitamin D c. Vitamin A d. Vitamin K

6. Which vitamin is given to newborns shortly after delivery?

ANS: D

Vitamin K deficiency in newborns is a result of malabsorption attributable to inadequate amounts of bile. Thus, vitamin K is given in a single intramuscular dose to infants shortly after delivery.

DIF: Cognitive Level: ApplicN at a. Vitamin B3 b. Vitamin B1 c. Vitamin B2 d. Vitamin B6

7. A patient with a history of alcohol abuse has been admitted to hospital for severe weakness and malnutrition. Which preparation will he receive to prevent Wernicke‘s encephalopathy?

ANS: B

Vitamin B1 (thiamine) is useful in the treatment of a variety of thiamine deficiencies, including Wernicke‘s encephalopathy.

DIF: Cognitive Level: Comprehension REF: p. 140 a. Vitamin A b. Vitamin B c. Vitamin C d. Vitamin D

8. People who live in Canada‘s North often have a lack of which vitamin?

ANS: D

Vitamin D, the ―sunshine vitamin,‖ is naturally produced by the sun. People who live in Canada‘s North, which lacks sunlight for much of the year, dress for intense cold, which reduces their opportunity for taking in vitamin D.

DIF: Cognitive Level: Knowledge REF: p. 136

Multiple Response

1. Which statement is true in regard to vitamin C? (Select all that apply.)

(Your answer should appear as lowercase letters separated by a comma and a space as follows: a, b, c, d) a. Vitamin C is important in the maintenance of bones, teeth, and capillaries. b. Vitamin C is important for erythropoiesis. c. Glycogenolysis relies on the presence of vitamin C. d. Vitamin C is important for tissue repair. e. Vitamin C is essential for the synthesis of blood coagulation factors. f. Vitamin C is found in animal sources, such as dairy products and meat. g. Vitamin C is found in citrus fruits, tomatoes, cabbage, and strawberries. h. Vitamin C is essential for night vision.

ANS: A, B, D, G

Vitamin C is important in the maintenance of bones, teeth, and capillaries; for erythropoiesis; and for tissue repair. Vitamin C is found in citrus fruits, tomatoes, cabbage, and strawberries.

Vitamin C deficiency is known as scurvy.

DIF: Cognitive Level: Comprehension REF: p. 133| pp. 144-145

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